Weight loss hypothyroid treatment. Weight Loss and Hypothyroidism Treatment: Unveiling the Truth

07.11.197625.10.2021 by alexxlab

Does treating hypothyroidism lead to weight loss. How does levothyroxine therapy affect body composition in hypothyroid patients. What are the mechanisms behind weight changes in hypothyroidism. How does thyroid hormone replacement impact resting energy expenditure and physical activity.

Содержание

The Relationship Between Hypothyroidism and Weight Gain

Hypothyroidism, characterized by decreased thyroid function, is commonly associated with weight gain. This connection has led many to believe that treating hypothyroidism will automatically result in significant weight loss. However, recent research challenges this assumption, revealing a more complex relationship between thyroid hormone replacement therapy and body weight changes.

Levothyroxine Treatment and Weight Loss: Surprising Findings

A study presented at the 83rd Annual Meeting of the American Thyroid Association in 2013 shed new light on the impact of levothyroxine (LT4) treatment on weight loss in hypothyroid patients. The researchers conducted a retrospective review of patients with newly diagnosed primary hypothyroidism over an 8-year period. What did they discover?

Only 52% of patients lost weight up to 24 months after starting LT4 treatment
Weight loss was modest, with a mean loss of 8.4 Â± 9.7 lbs
The study excluded cases of hypothyroidism caused by thyroid cancer, pregnancy, or associated with prescription weight loss medication

These findings challenge the widespread belief that treating hypothyroidism automatically leads to significant weight loss in most patients.

Understanding Body Composition Changes in Treated Hypothyroidism

To gain deeper insights into the mechanisms behind weight changes in hypothyroidism, researchers conducted a one-year controlled follow-up study. This study, published in The Journal of Clinical Endocrinology & Metabolism, provides valuable information about body composition changes during thyroid hormone replacement therapy.

Study Design and Participants

12 outpatients newly diagnosed with hypothyroidism
10 euthyroid individuals as a control group
1-year follow-up period

Key Measurements

Body mass and composition (using dual-energy x-ray analysis scan)
Resting energy expenditure (REE) (measured by indirect calorimetry)
Spontaneous physical activity (assessed using pedometers and two different questionnaires)

The Impact of Levothyroxine Therapy on Thyroid Function and Body Weight

After one year of levothyroxine treatment, significant changes were observed in thyroid function and body weight:

TSH levels decreased from 102 (85) to 2.2 (2.1) mU/liter
Free T4 levels increased from 4.5 (2.1) to 18 (3.3) pmol/liter
Body weight decreased from 83.7 (16.4) to 79.4 (16.0) kg (P = 0.002)

These results demonstrate that levothyroxine therapy effectively normalized thyroid function and led to a statistically significant reduction in body weight. However, it’s important to note that the weight loss was relatively modest, consistent with the findings from the earlier study.

Unraveling the Mechanisms of Weight Loss in Treated Hypothyroidism

The study’s findings provide intriguing insights into the mechanisms behind weight changes in treated hypothyroidism:

Changes in Body Composition

Interestingly, the observed weight loss was primarily due to changes in lean mass:

Significant decrease in lean mass subcompartment (P = 0.001)
Fat mass remained virtually unchanged
Bone mass showed no significant changes

These results suggest that the weight loss associated with hypothyroidism treatment is not primarily due to fat loss, as many might assume.

Resting Energy Expenditure (REE)

The study revealed a significant increase in resting energy expenditure following levothyroxine therapy. This finding aligns with the known effects of thyroid hormones on metabolism and energy expenditure.

Physical Activity

The impact of hypothyroidism treatment on physical activity yielded mixed results:

Significant increase in physical activity measured with questionnaires
No significant change in daily steps measured by pedometers

This discrepancy highlights the importance of using multiple assessment methods when evaluating changes in physical activity.

The Role of Excess Body Water in Hypothyroidism-Related Weight Changes

One intriguing aspect of weight loss in treated hypothyroidism is the potential role of excess body water. The study’s title suggests that weight loss after hypothyroidism therapy is mainly caused by the excretion of excess body water associated with myxoedema. Myxoedema is a condition characterized by the accumulation of mucopolysaccharides in the dermis, leading to swelling and puffiness, particularly in the face and extremities.

How does this relate to the observed changes in body composition?

The decrease in lean mass could be partially attributed to the loss of excess water
This explanation aligns with the clinical observation of reduced puffiness and swelling in treated hypothyroid patients
It also explains why fat mass remains relatively unchanged despite overall weight loss

Implications for Patient Care and Expectations

The findings from these studies have important implications for both healthcare providers and patients:

Managing Weight Loss Expectations

Patients and physicians should be aware that treating hypothyroidism may not always result in significant weight loss. While some weight loss is possible, it is often modest and may not be sufficient to achieve a normal body weight in overweight or obese individuals.

Addressing Obesity in Hypothyroid Patients

As Dr. Ronald J. Koenig, Professor at the University of Michigan Medical Center, points out, obesity and hypothyroidism often coexist. It’s crucial not to assume that hypothyroidism is the sole or primary cause of obesity in these patients. A comprehensive approach to weight management, including diet and exercise, may be necessary in addition to thyroid hormone replacement therapy.

Monitoring Body Composition

Given the specific changes in body composition observed in treated hypothyroidism, healthcare providers may want to consider monitoring not just overall weight but also body composition in these patients. This could provide a more accurate picture of treatment effects and help guide further interventions if needed.

Future Research Directions

While these studies provide valuable insights, they also raise new questions and highlight areas for future research:

Long-term follow-up to assess the sustainability of weight changes and body composition alterations
Investigation of factors that predict weight loss response to hypothyroidism treatment
Exploration of the relationship between thyroid hormone levels, energy expenditure, and physical activity in treated hypothyroid patients
Development of targeted interventions to address weight management in hypothyroid patients who do not experience significant weight loss with treatment alone

As our understanding of the complex relationship between thyroid function, body weight, and metabolism continues to evolve, these research directions will be crucial in refining treatment approaches and improving outcomes for patients with hypothyroidism.

The Importance of Individualized Care in Hypothyroidism Treatment

The findings from these studies underscore the importance of individualized care in the treatment of hypothyroidism. While levothyroxine therapy is effective in normalizing thyroid function and can lead to some weight loss, the response varies among patients. Healthcare providers should consider the following factors when managing hypothyroid patients with weight concerns:

Comprehensive Assessment

A thorough evaluation of each patient’s unique circumstances is essential. This may include:

Detailed medical history, including the onset and progression of hypothyroid symptoms
Assessment of dietary habits and physical activity levels
Evaluation of other potential contributors to weight gain, such as medications or concurrent medical conditions
Measurement of body composition, not just overall weight

Realistic Goal Setting

Based on the research findings, it’s important to help patients set realistic expectations regarding weight loss following hypothyroidism treatment. This may involve:

Educating patients about the modest weight loss typically observed with treatment
Emphasizing the health benefits of thyroid hormone replacement beyond weight loss
Encouraging focus on overall well-being rather than solely on the number on the scale

Adjunctive Therapies

For patients who do not achieve desired weight loss with levothyroxine treatment alone, consider adjunctive therapies:

Personalized nutrition plans tailored to the patient’s metabolic needs
Structured exercise programs that account for any lingering fatigue or joint issues
Behavioral interventions to address any emotional eating patterns that may have developed during the hypothyroid state
In some cases, referral to a weight management specialist or endocrinologist for more intensive interventions

Regular Monitoring and Adjustment

The treatment of hypothyroidism and associated weight issues should be an ongoing process:

Regular follow-up appointments to assess thyroid function and adjust levothyroxine dosage as needed
Periodic reassessment of body composition and weight
Ongoing evaluation of energy levels, physical activity, and overall quality of life
Adjustment of treatment plans based on individual response and changing needs

By adopting a patient-centered, comprehensive approach to hypothyroidism treatment, healthcare providers can help patients achieve optimal thyroid function while addressing weight concerns in a realistic and sustainable manner. This individualized care strategy acknowledges the complex interplay between thyroid hormones, metabolism, and body weight, and sets the stage for improved long-term outcomes in hypothyroid patients.

Does Treatment of Hypothyroidism Lead to Weight Loss

October 16, 2013 — Decreased thyroid function, or hypothyroidism, is commonly associated with weight gain. But contrary to popular belief, effective treatment with levothyroxine (LT4) to restore normal thyroid hormone levels is not associated with clinically significant weight loss in most people. The study that led to this surprising finding will be presented by researchers from Boston University Medical Center at the 83rd Annual Meeting of the American Thyroid Association, October 16-20, 2013, in San Juan, Puerto Rico.

In “Weight Change after Treatment of Hypothyroidism,” SY Lee, LE Braverman, and EN Pearce describe the retrospective review of patients with newly diagnosed primary hypothyroidism over an 8-year period, not caused by thyroid cancer or other forms of disease or associated with pregnancy or use of prescription weight loss medication.

About half (52%) of the patients lost weight up to 24 months after initiation of treatment with LT4. Overall, weight loss was modest, with a mean weight loss of 8.4 + 9.7 lbs.

“Because obesity and hypothyroidism are very common, there are many patients who have both conditions,” says Ronald J. Koenig, M.D., Ph.D, Program Committee Co-Chair, and Professor, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor. “These patients (and sometimes their physicians) often assume the hypothyroidism is causing the obesity even though this may not be the case. This study is important because it shows, unfortunately, that only about half of hypothyroid patients lose weight after the successful treatment of their hypothyroidism. It will be interesting and important to have follow up data to know whether the patients that lose weight are the ones most in need of weight loss, and to know how significantly their weight loss contributed toward achieving a normal body weight.”

About the ATA

The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis and treatment of thyroid disorders and thyroid cancer. ATA is an international individual membership organization with over 1,700 members from 43 countries around the world. Celebrating its 90^th anniversary, ATA delivers its mission through several key endeavors: the publication of highly regarded monthly journals, THYROID, Clinical Thyroidology (CT), VideoEndocrinology and CT for Patients; annual scientific meetings; biennial clinical and research symposia; research grant programs for young investigators, support of online professional, public and patient educational programs through www.thyroid.org; and the development of guidelines for clinical management of thyroid disease. Visit www.thyroid.org for more information.

Media Contact
Bobbi Smith
Executive Director of the American Thyroid Association
Email: [email protected]

Weight Loss after Therapy of Hypothyroidism Is Mainly Caused by Excretion of Excess Body Water Associated with Myxoedema | The Journal of Clinical Endocrinology & Metabolism

Context: In hypothyroidism, resting energy expenditure (REE) is reduced and weight gain is common. Physical activity contributes to the total daily energy expenditure, and changes in physical activity might contribute to hypothyroid-associated weight changes.

Objective: The objective of the present study was to evaluate mechanisms involved in body weight changes associated with hypothyroidism.

Design, Setting, and Participants: We conducted a 1-yr controlled follow-up study on outpatients newly diagnosed with hypothyroidism (n = 12) and a euthyroid measurement control group (n = 10).

Main Outcome and Interventions: Changes in body mass and composition (dual-energy x-ray analysis scan), REE (indirect calorimetry), and spontaneous physical activity (pedometers and two different questionnaires) were studied before and after 12 months of l-T₄ therapy or observation (control group).

Results: TSH changed from 102 (85) to 2.2 (2.1) mU/liter mean (SD) and free T₄ from 4.5 (2.1) to 18 (3. 3) pmol/liter after 1 yr of treatment. Body weight decreased from 83.7 (16.4) to 79.4 (16.0) kg (P = 0.002) due to change in the lean mass subcompartment only (P = 0.001) because fat and bone mass was virtually unchanged. Significant increase was observed in REE and in physical activity measured with questionnaires but not measured as daily steps. No significant changes were observed in the control group.

Conclusion:l-T₄ therapy of hypothyroidism associated with significant decrease in body weight and increase in REE. Physical activity measured with questionnaires increased significantly, but not number of daily steps. Despite changes in REE and body weight, fat mass was unchanged during the study. We propose that total body energy equilibrium is maintained during treatment of hypothyroidism and that weight loss observed during such treatment is caused by excretion of excess body water associated with untreated myxoedema.

Changes in body weight are common in patients with hypothyroidism (1). In general, weight changes are due to either a mismatch between energy intake and energy expenditure leading to accumulation or loss of body fat or a change in body water content secondary to disease or medication. The total daily energy expenditure is a sum of the basal metabolic rate (on the order of 60%), the energy required for physical activity (on average 10–30%), and the thermogenic effect of food (usually 10%) (2).

The thyroid hormones are important determinants of the basal metabolic rate (3), which is a likely cause for the correlation between biochemical thyroid function and body mass index that has been observed even in euthyroid subjects (4). Another possible weight-increasing mechanism in hypothyroidism is a decreasing level of spontaneous physical activity level. In man, hypothyroidism has been shown to influence skeletal muscle metabolism and function (5, 6), and psychomotor slowing and impaired cardiac output has also been shown (7, 8). It may thus be speculated that hypothyroidism is associated with a reduced physical activity level that may contribute some of the body weight changes often observed in this disease.

Finally, hypothyroidism is associated with accumulation of water-binding glycosaminoglycans which led to the term myxoedema (9). It is conceivable that changes in body water content might be involved in the weight changes in hypothyroidism.

To clarify mechanisms involved in body weight changes associated with hypothyroidism, we assessed the body composition, resting energy expenditure (REE) and physical activity level in patients with overt hypothyroidism before and after 12 months of L-T₄ replacement therapy.

Patients and Methods

We consecutively included patients with newly diagnosed autoimmune overt hypothyroidism referred to our unit by their general practitioner. Exclusion criteria were previous thyroid disease, hypothyroidism treated for more than 1 wk, use of medication that could interfere with thyroid function tests, a psychiatric diagnosis, physical incapacity, pregnancy within 12 months or age under 18 or above 80 yr.

Twelve patients were included and underwent physical investigation, measurement of body composition, REE, and evaluation of physical activity. During the study, the patients’ general practitioner regularly monitored thyroid function and adjusted the l-T₄ treatment accordingly. Blood samples for the study were obtained at baseline and after 1 yr of l-T₄ treatment. The patients were also investigated after 1, 2, 3, and 6 months with pedometers and the physical activity questionnaire. The patients attended the investigational sessions after an overnight fast.

Informed consent was signed before entering the study, which was approved by the Regional Ethics Committee for North-Jutland and Viborg County, Denmark.

Body composition

Dual-energy x-ray analysis scan (XR-36 wbl; Norland, Fort Atkinson, WI), weighing (SECA, Hamburg, Germany), and height measurements (Harpenden Stadiometer, Crosswell, UK) were performed with participants in light clothing, without shoes, and after voiding.

Resting energy expenditure

REE was measured with indirect calorimetry on an open-circuit system using a Deltatrack II metabolic monitor (Datex, Helsinki, Finland). Flow and gas concentration measurements were performed every minute for 30 min, and the last 20 recordings were used for calculation of REE, expressed as kilocalories per 24 h.

Physical activity

Physical activity was studied using three different methods: step counting and two different questionnaires.

Sealed pedometers (SW-200; Yamax, Tokyo, Japan) worn on the waistband were used for step counting. The patients were asked to ambulate as usual and to wear the pedometer during all waking hours. Measurements were performed on days of ordinary life, not weekends or holidays (10). Measurements with daily step counts fewer than 1000 were considered measurement failures and discarded. The mean of 3 d of pedometer measurements was used for the calculations.

In the physical activity questionnaire, the participants reports how many hours per day they are engaged in nine different levels of physical activity (11). This yields a total physical activity score reflecting physical activity level during an average working day the previous month.

The physical component summary from the general quality-of-life questionnaire Short Form 36 (SF-36) version 1 in Danish was used (12). In both questionnaires, a higher score is better.

Evaluation of constancy of the measurements

A control group was included concurrently to validate the constancy of the measurement methods. Ten patients treated with radioactive iodine for euthyroid goiter more than 1 yr previously was included. All participants were euthyroid throughout the study, two harbored thyroid peroxidase autoantibodies, and none received l-T₄ treatment or antithyroid drugs at any point in time. Apart from a minimal increase in TSH, no significant changes were observed in any of the variables listed in Table 1 in the control patients after 1 yr.

TABLE 1.

Characteristics, hormone levels, body composition, REE, and physical activity in hypothyroid patients at inclusion and after 1 yr

.	Mean (sd) .
.	Baseline .	After 1 yr .	P .
Age (yr)	55 (12)	56 (12)	NA
Sex (male/female) (n)	6/6	6/6	NA
Working/retired (n)	5/7	5/7	NA
Smokers (n)	3	3	NA
Serum TSH (mU/liter)	102 (85.0)	2.2 (2.1)	0.004
Serum fT₄ (pmol/liter)	4. 5 (2.1)	18 (3.3)	<0.001
Serum fT₃ (pmol/liter)	2.3 (1.0)	4.7 (0.67)	<0.001
Weight (kg)	83.7 (16.4)	79.4 (16.0)	0.002
BMI (kg/m²)	28.5 (4.79)	26.8 (4.27)	0.001
Fat mass (kg)	28.1 (10.0)	27.8 (8.82)	0.70
Lean mass (kg)	52.3 (11.6)	48.5 (12.0)	0.001
Bone mass (kg)	3.0 (0.52)	3.0 (0.52)	0.26
REE (kcal/24 h)	1320 (244.1)	1460 (256.2)	0.023
REE/lean mass (kcal/24 h · kg)	0.026 (0.003)	0.031 (0.005)	0.004
Steps/d	6594 (2065)	7399 (3181)	0.55
PA score	41. 5 (8.39)	48.2 (12.1)	0.025
PCS score	43.9 (9.29)	48.8 (8.65)	0.034

.	Mean (sd) .
.	Baseline .	After 1 yr .	P .
Age (yr)	55 (12)	56 (12)	NA
Sex (male/female) (n)	6/6	6/6	NA
Working/retired (n)	5/7	5/7	NA
Smokers (n)	3	3	NA
Serum TSH (mU/liter)	102 (85.0)	2.2 (2.1)	0.004
Serum fT₄ (pmol/liter)	4.5 (2.1)	18 (3.3)	<0.001
Serum fT₃ (pmol/liter)	2. 3 (1.0)	4.7 (0.67)	<0.001
Weight (kg)	83.7 (16.4)	79.4 (16.0)	0.002
BMI (kg/m²)	28.5 (4.79)	26.8 (4.27)	0.001
Fat mass (kg)	28.1 (10.0)	27.8 (8.82)	0.70
Lean mass (kg)	52.3 (11.6)	48.5 (12.0)	0.001
Bone mass (kg)	3.0 (0.52)	3.0 (0.52)	0.26
REE (kcal/24 h)	1320 (244.1)	1460 (256.2)	0.023
REE/lean mass (kcal/24 h · kg)	0.026 (0.003)	0.031 (0.005)	0.004
Steps/d	6594 (2065)	7399 (3181)	0.55
PA score	41.5 (8.39)	48.2 (12.1)	0.025
PCS score	43.9 (9. 29)	48.8 (8.65)	0.034

TABLE 1.

Characteristics, hormone levels, body composition, REE, and physical activity in hypothyroid patients at inclusion and after 1 yr

.	Mean (sd) .
.	Baseline .	After 1 yr .	P .
Age (yr)	55 (12)	56 (12)	NA
Sex (male/female) (n)	6/6	6/6	NA
Working/retired (n)	5/7	5/7	NA
Smokers (n)	3	3	NA
Serum TSH (mU/liter)	102 (85.0)	2.2 (2.1)	0.004
Serum fT₄ (pmol/liter)	4.5 (2.1)	18 (3.3)	<0.001
Serum fT₃ (pmol/liter)	2. 3 (1.0)	4.7 (0.67)	<0.001
Weight (kg)	83.7 (16.4)	79.4 (16.0)	0.002
BMI (kg/m²)	28.5 (4.79)	26.8 (4.27)	0.001
Fat mass (kg)	28.1 (10.0)	27.8 (8.82)	0.70
Lean mass (kg)	52.3 (11.6)	48.5 (12.0)	0.001
Bone mass (kg)	3.0 (0.52)	3.0 (0.52)	0.26
REE (kcal/24 h)	1320 (244.1)	1460 (256.2)	0.023
REE/lean mass (kcal/24 h · kg)	0.026 (0.003)	0.031 (0.005)	0.004
Steps/d	6594 (2065)	7399 (3181)	0.55
PA score	41.5 (8.39)	48.2 (12.1)	0.025
PCS score	43.9 (9. 29)	48.8 (8.65)	0.034

.	Mean (sd) .
.	Baseline .	After 1 yr .	P .
Age (yr)	55 (12)	56 (12)	NA
Sex (male/female) (n)	6/6	6/6	NA
Working/retired (n)	5/7	5/7	NA
Smokers (n)	3	3	NA
Serum TSH (mU/liter)	102 (85.0)	2.2 (2.1)	0.004
Serum fT₄ (pmol/liter)	4.5 (2.1)	18 (3.3)	<0.001
Serum fT₃ (pmol/liter)	2.3 (1.0)	4.7 (0.67)	<0.001
Weight (kg)	83. 7 (16.4)	79.4 (16.0)	0.002
BMI (kg/m²)	28.5 (4.79)	26.8 (4.27)	0.001
Fat mass (kg)	28.1 (10.0)	27.8 (8.82)	0.70
Lean mass (kg)	52.3 (11.6)	48.5 (12.0)	0.001
Bone mass (kg)	3.0 (0.52)	3.0 (0.52)	0.26
REE (kcal/24 h)	1320 (244.1)	1460 (256.2)	0.023
REE/lean mass (kcal/24 h · kg)	0.026 (0.003)	0.031 (0.005)	0.004
Steps/d	6594 (2065)	7399 (3181)	0.55
PA score	41.5 (8.39)	48.2 (12.1)	0.025
PCS score	43.9 (9.29)	48.8 (8.65)	0.034

Hormone assays

Serum TSH, free T₄ (fT₄), and free T₃ (fT₃) were measured in duplicate in random order using an electrochemiluminescence immunoassay method on a Modular Analytics E170 (Roche, Germany).

Statistical evaluation

Conformation to normal distribution was tested with quintile-quintile normal distribution plots and the Shapiro-Wilks test. Except for fT₄ hormone levels, where nonparametric tests were used, data followed the normal distribution, and parametric tests were used. A P value <0.05 was considered statistically significant. The Statistical Package for Social Sciences version 11.0 (SPSS, Chicago, IL) and Excel 2003 (Microsoft Corp., Redmond, WA) were used for the calculations.

Results

Patients’ characteristics and thyroid function tests at inclusion and after 12 months are shown in Table 1. All hypothyroid patients harbored thyroid peroxidase autoantibodies.

Body composition and REE

Body weight decreased on average 4. 3 kg after 1 yr of l-T₄ therapy. This decrease in total body weight was caused by a significant decrease of 3.8 kg in the lean mass subcompartment (Table 1). A small and insignificant decrease was observed in the fat mass subcompartment, and bone mass was equal between the two measurements. At study entry, the patients were asked about their weight 6 months earlier. This recalled weight was 82.1 (14.4) kg, with an estimated increase in weight during the 6 months before inclusion of 2.8 kg. Recalled weight was significantly different from the weight at inclusion (P = 0.03) but not after 12 months (P = 0.37).

Unadjusted REE as well as REE/lean mass (in kilograms) increased significantly, 11.6 and 21.8%, respectively, after 1 yr of treatment (Table 1).

fT₄ predicted body weight changes during l-T₄ treatment, because baseline fT₄ hormone levels correlated (Spearmans ρ = 0.64; P = 0.035) to the decrease in body weight during the year. This correlation was also significant for changes in the lean mass subcompartment (Spearmans ρ = 0.66; P = 0.029) but not for fat (Spearmans ρ = 0.055; P = 0.87) or bone mass (Spearmans ρ = −0.30; P = 0.37) changes during the year.

Physical activity level

The step counts varied widely from day to day in all the participants. No significant trend (Friedman, P = 0.99) or change (P = 0.55) occurred in number of daily steps during the year (Fig. 1, upper panel).

Fig. 1.

Mean (±sem) of the measured number of steps per day (upper panel, Friedman P = 0.41) and physical activity score (lower panel, Friedman P = 0.018) at baseline and during 12 months of l-T₄ replacement therapy.

Fig. 1.

The physical activity score during the study (Fig. 1, lower panel) increased during the year (Friedman, P = 0.018) and after 1 yr (P = 0.025). The physical component summary evaluated by the SF-36 increased markedly after 1 yr (Table 1).

Discussion

Changes in body weight during treatment of hypothyroidism

As expected, therapy of hypothyroidism was followed by a moderate decrease in body weight. Intuitively, it might be speculated that such weight loss was mainly caused by loss of body weight due to an increase in energy expenditure. The average increase in REE after 1 yr of therapy was 215 kcal/24 h. If this increase in REE was effective during 6 months of the treatment period, this transforms to combustion of 4.4 kg of fat tissue. This theoretical estimate contrasts the virtual absence of change in body fat observed. We did not quantify the energy intake during the study, but it may be hypothesized that increased energy intake had efficiently counteracted the energy loss from an increase in REE and spontaneous physical activity level in the hypothyroid patients studied. In rats, low doses of T₃ has orexigenic effects without interfering the REE or the locomotor activity (13).

Changes in physical activity during treatment of hypothyroidism

The spontaneous physical activity level has not previously been studied in patients with hypothyroidism. We found that during treatment, physical activity increased as evaluated with questionnaires, but not as daily steps taken. The coefficient of variation during the year was 27% in the physical activity questionnaire compared with 42% for the pedometer measurements. The large variation in the pedometer measurements is a major drawback to detect changes. In keeping with this, we found no significant changes in step count during the year.

Another possible explanation for the lack of difference in step counts is that the measured numbers of steps represent a necessary minimum to maintain the everyday lifestyle habits of the individual, and this may be largely unaffected by the fact that the patients were hypothyroid. The questionnaires, on the other hand, may reflect the self-experienced burden of the necessary physical activity and may also be influenced by the difference between what the individual actually does and assumes he or she should be able to do.

Possible mechanisms of weight loss during treatment of hypothyroidism

The only significant predictor of the 5% decrease in body weight during l-T₄ therapy in hypothyroid patients was baseline fT₄ level. The weight change was caused by a change in lean body mass, because fat mass was largely unaltered. A dual-energy x-ray analysis scan provide a two-component soft tissue model consisting of fat mass and lean mass subcompartments, the latter comprising water, proteins, glycogen, and minerals not tied to bone (14). Hypothyroid patients have reduced capacity of renal free-water excretion (15), increased antidiuretic hormone level (16), and increased amount in tissues of glycosaminoglycans, which have large water-binding capacity (17). Other water-retaining mechanisms from increased protein extravasation to a decreased lymphatic drainage have also been described (18). The high water content of the skin, observed in severe hypothyroidism, originated the term myxoedema (9). Soon after the description of myxoedema, it was noted that therapy with thyroid hormones was followed by an increase in urine output in such patients (19).

Strengths and limitations

Strengths of this study are the evaluation of the spontaneous level of physical activity using three different methods and the addition of a measurement control group. Limitations are the lack of registration of energy intake and of measurement of the thermogenic effect of food.

Conclusion

One year of l-T₄ treatment of hypothyroidism was associated with decreased body weight attributable to a decrease in lean mass because total fat mass was largely unchanged. REE increased during treatment as did the physical activity level measured with two different questionnaires, but not when measured as daily steps taken. We hypothesize that during l-T₄ replacement therapy of hypothyroidism, the total body energy equilibrium is maintained, and the weight loss often observed during such treatment is predominantly due to loss of excess body water accumulated during the state of myxoedema.

We are indebted to laboratory technicians Ingelise Leegaard, Anne-Mette Christensen, and Anette Godsk for invaluable assistance with thyroid ultrasound investigations and biochemical analyses.

The kits for the hormonal analyses were kindly provided by Roche. Speciallæge Heinrich Kopps legat provided financial funding for the study.

Disclosure Summary: All authors have nothing to declare.

Abbreviations:

fT₄,

REE,
resting energy expenditure;

SF-36,

Zulewski

Müller

Exer

Miserez

Staub

1997

Estimation of tissue hypothyroidism by a new clinical score: evaluation of patients with various grades of hypothyroidism and controls.

J Clin Endocrinol Metab

771

–

776

Toth

1999

Energy expenditure in wasting diseases: current concepts and measurement techniques.

Curr Opin Clin Nutr Metab Care

445

–

451

Kim

2008

Thyroid hormone as a determinant of energy expenditure and the basal metabolic rate.

Thyroid

141

–

144

Knudsen

Laurberg

Rasmussen

Bülow

Perrild

Ovesen

Jørgensen

2005

Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population.

J Clin Endocrinol Metab

4019

–

4024

Visser

Heemstra

Swagemakers

Ozgür

Corssmit

Burggraaf

van Ijcken

van der Spek

Smit

Visser

2009

Physiological thyroid hormone levels regulate numerous skeletal muscle transcripts.

J Clin Endocrinol Metab

3487

–

3496

Simonides

van Hardeveld

2008

Thyroid hormone as a determinant of metabolic and contractile phenotype of skeletal muscle.

Thyroid

205

–

216

Klein

Ojamaa

2001

Thyroid hormone and the cardiovascular system.

N Engl J Med

344

501

–

509

Dugbartey

1998

Neurocognitive aspects of hypothyroidism.

Arch Intern Med

158

1413

–

1418

Ord

1878

On myxoedema: a term proposed to be applied to an essential condition in the “cretinoid” affection occasionally observed in middle aged women.

Med Chir Trans

–

Tudor-Locke

Burkett

Reis

Ainsworth

Macera

Wilson

2005

How many days of pedometer monitoring predict weekly physical activity in adults?

Prev Med

293

–

298

Aadahl

Jørgensen

2003

Validation of a new self-report instrument for measuring physical activity.

Med Sci Sports Exerc

1196

–

1202

Bjorner

Damsgaard

Watt

Groenvold

1998

Tests of data quality, scaling assumptions, and reliability of the Danish SF-36.

J Clin Epidemiol

1001

–

1011

Kong

Martin

Smith

Gardiner

Connoley

Stephens

Dhillo

Ghatei

Small

Bloom

2004

Tri-iodothyronine stimulates food intake via the hypothalamic ventromedial nucleus independent of changes in energy expenditure.

Endocrinology

145

5252

–

5258

Pietrobelli

Formica

Wang

Heymsfield

1996

Dual-energy x-ray absorptiometry body composition model: review of physical concepts.

Am J Physiol

271

E941

–

E951

Sahún

Villabona

Rosel

Navarro

Ramón

Gómez

Soler

2001

Water metabolism disturbances at different stages of primary thyroid failure.

J Endocrinol

168

435

–

445

Park

Shin

Ahn

Kim

Choi

Chang

Bang

2001

Thyroxine treatment induces upregulation of renin-angiotensin-aldosterone system due to decreasing effective plasma volume in patients with primary myxoedema.

Nephrol Dial Transplant

1799

–

1806

Smith

Bahn

Gorman

1989

Connective tissue, glycosaminoglycans, and diseases of the thyroid.

Endocr Rev

366

–

391

Parving

Hansen

Nielsen

Rossing

Munck

Lassen

1979

Mechanisms of edema formation in myxedema: increased protein extravasation and relatively slow lymphatic drainage.

N Engl J Med

301

460

–

465

Fenwick

1891

The diuretic action of fresh thyroid juice.

BMJ

798

–

799

Thyroid and weight – the science

For many thyroid patients, weight control is one of their biggest frustrations. This article, written by the American Thyroid Association sets out why and how thyroid disorders affect a person’s weight

What is the relationship between thyroid and weight?

It has been appreciated for a very long time that there is a complex relationship between thyroid disease, body weight and metabolism. Thyroid hormone regulates metabolism in both animals and humans. Metabolism is determined by measuring the amount of oxygen used by the body over a specific amount of time. If the measurement is made at rest, it is known as the basal metabolic rate (BMR). In fact, measurement of the BMR was one of the earliest tests used to assess a patient’s thyroid status. Patients whose thyroid glands were not working were found to have low BMRs, and those with over-active thyroid glands had high BMRs. Later studies linked these observations with measurements of thyroid hormone levels and showed that low thyroid hormone levels were associated with low BMRs and high thyroid hormone levels were associated with high BMRs. Most doctors no longer use BMR due to the complexity in doing the test and because the BMR is subject to many other influences other than the state of the thyroid.

What is the relationship between BMR and weight?

Differences in BMRs are associated with changes in energy balance. Energy balance reflects the difference between the amount of calories eaten and the amount of calories the body uses. If a high BMR is induced by the administration of drugs, such as amphetamines, animals often have a negative energy balance which leads to weight loss. Based on such studies many people have concluded that changes in thyroid hormone levels, which lead to changes in BMR, should also cause changes in energy balance and similar changes in body weight. However, BMRs are not the whole story relating weight and thyroid. For example, when metabolic rates are reduced in animals by various means (for example by decreasing the body temperature), these animals often do not show the expected excess weight gain. Thus, the relationship between metabolic rates, energy balance, and weight changes is very complex. There are many other hormones (besides thyroid hormone), proteins, and other chemicals that are very important for controlling energy expenditure, food intake, and body weight. Because all these substances interact on both the brain centers that regulate energy expenditure and tissues throughout the body that control energy expenditure and energy intake, it is difficult to predict the effect of altering only one of these factors (such as thyroid hormone) on body weight as a whole. As a consequence, at this time, it is impossible to predict the effect of a changing thyroid state on any individual’s body weight.

Why do I gain weight when hyperthyroidism is treated?

Because being hyperthyroid is an abnormal state, any weight loss caused by the abnormal state would not be maintained when the abnormal state is reversed, and this is what is found. On average, any weight lost during the hyperthyroid state is regained when the hyperthyroidism is treated. One consequence of this observation is that the use of thyroid hormone to treat obesity is not very useful. Once thyroid hormone treatment is stopped, any weight that is lost while on treatment will be regained after treatment is discontinued.

What is the relationship between hypothyroidism and weight gain?

Since the BMR in a person with hypothyroidism is decreased, an under-active thyroid is generally associated with some weight gain. The weight gain is often greater in those individuals with more severe hypothyroidism. However, the decrease in BMR due to hypothyroidism is usually much less dramatic than the marked increase seen in hyperthyroidism, leading to smaller alterations in weight due to an under-active thyroid. The cause of the weight gain in a hypothyroid person is also complex, and not always related to excess fat accumulation. Most of the extra weight gained in hypothyroid individuals is due to excess accumulation of salt and water. Massive weight gain is rarely associated with hypothyroidism. In general, 5-10 pounds of body weight may be attributable to the thyroid, depending on the severity of the hypothyroidism. Finally, if weight gain is the only symptom of hypothyroidism that is present, it is less likely that the weight gain is solely due to the thyroid.

How much weight can I expect to lose once the hypothyroidism is treated?

Since much of the weight gain in hypothyroidism is accumulation in salt and water, when the hypothyroidism is treated one can expect a small (usually less than 10% of body weight) weight loss. As in the treatment with hyperthyroidism, treatment of the abnormal state of hypothyroidism with thyroid hormone should result in a return of body weight to what it was before the hypothyroidism developed. However, since hypothyroidism usually develops over a long period of time, it is fairly common to find that there is no significant weight loss after successful treatment of hypothyroidism. Again, if all of the other symptoms of hypothyroidism, with the exception of weight gain, are resolved with treatment with thyroid hormone, it is less likely that the weight gain is solely due to the thyroid. Once hypothyroidism has been treated and thyroid hormone levels have returned to the normal range of thyroid hormone, the ability to gain or lose weight is the same as in individuals who do not have thyroid problems.

Can thyroid hormone be used to help me lose weight?

Thyroid hormones have been used as a weight loss tool in the past. Many studies have shown that excess thyroid hormone treatment can help produce more weight loss than can be achieved by dieting alone. However, once the excess thyroid hormone is stopped, the excess weight loss is usually regained. Furthermore, there may be significant negative consequences from the use of thyroid hormone to help with weight loss, such as the loss of muscle protein in addition to any loss of body fat. Pushing the thyroid hormone dose to cause thyroid hormone levels to be elevated is unlikely to significantly change weight and may result in other metabolic problems.

This information is reproduced from the American Thyroid Association FAQ on Thyroid and Weight

The American Thyroid Association (ATA) has lots of up-to-date and accessible information on thyroid disorders.

We rely on donations to fund our work supporting and informing people living with thyroid disorders. Please consider making a donation or becoming a member

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Published:
2^nd September, 2019

Updated:
6^th October, 2020

Author:

Bethany Frost

Weight loss after therapy of hypothyroidism is mainly caused by excretion of excess body water associated with myxoedema

Context:

In hypothyroidism, resting energy expenditure (REE) is reduced and weight gain is common. Physical activity contributes to the total daily energy expenditure, and changes in physical activity might contribute to hypothyroid-associated weight changes.

Objective:

The objective of the present study was to evaluate mechanisms involved in body weight changes associated with hypothyroidism.

Design, setting, and participants:

We conducted a 1-yr controlled follow-up study on outpatients newly diagnosed with hypothyroidism (n = 12) and a euthyroid measurement control group (n = 10). MAIN OUTCOME AND INTERVENTIONS: Changes in body mass and composition (dual-energy x-ray analysis scan), REE (indirect calorimetry), and spontaneous physical activity (pedometers and two different questionnaires) were studied before and after 12 months of L-T(4) therapy or observation (control group).

Results:

TSH changed from 102 (85) to 2.2 (2.1) mU/liter mean (SD) and free T(4) from 4.5 (2.1) to 18 (3.3) pmol/liter after 1 yr of treatment. Body weight decreased from 83.7 (16.4) to 79.4 (16.0) kg (P = 0.002) due to change in the lean mass subcompartment only (P = 0.001) because fat and bone mass was virtually unchanged. Significant increase was observed in REE and in physical activity measured with questionnaires but not measured as daily steps. No significant changes were observed in the control group.

Conclusion:

L-T(4) therapy of hypothyroidism associated with significant decrease in body weight and increase in REE. Physical activity measured with questionnaires increased significantly, but not number of daily steps. Despite changes in REE and body weight, fat mass was unchanged during the study. We propose that total body energy equilibrium is maintained during treatment of hypothyroidism and that weight loss observed during such treatment is caused by excretion of excess body water associated with untreated myxoedema.

Weight Gain After Hyperthyroidism Treatment is Common: What to Know

With Kristien Boelaert, MD, PhD, and Reshmi Srinath, MD

After successful treatment for her overactive thyroid (hyperthyroidism), the patient (who we will call June), not only gained all excess the weight she had lost while her thyroid gland was in overdrive, but the weight continued to creep up.

This is common complaint repeated by many people who visit the discussion board on EndocrineWeb. Understandably, June was so distraught with the undesirable weight gain, so she stopped taking the medication meant to normalize her thyroid levels.

Treatment for hyperthyroidism may lead to excess weight gain if not addressed early. Photo: RapidEye @ iStock

What Prompts Hyperthyroid Related Weight Gain?

“This woman had developed thyroid storm,” says Kristien Boelaert, MD, PhD, associate professor of endocrinology at the University of Birmingham in the United Kingdom, and senior author of a new study focusing on weight gain after treatment for hyperthyroidism. Thyroid storm is a life-threatening condition in which body temperature, heart rate, and blood pressure often rise to dangerous levels.

These symptoms arose in “June,” landing her in the intensive care unit, Dr. Boelaert says, and required urgent medical attention. Just like this patient, many people are tempted to stop taking their antithyroid therapy with of the hope of lessening the weight gain, she says, and for those who do, the result is even worse medical complications.

In recognizing this common scenario, Dr. Boelaert and her colleagues were compelled to study the issue—exactly how much weight people typicaly gain while being treated for hyperthyroidism—and report their findings in the journal Thyroid.¹

Dr. Boelaert’s team found that many people do indeed gain weight, with some developing obesity. The data gathered from this study puts concrete numbers to this adverse effect of hyperthyroid treatment. Simple awareness of how common excess weight gain may be can be a big relief for patients, Dr. Boelaert tells EndocrineWeb; knowing that weight gain can occur means patients can take proactive steps to anticipate the problem and lessen the result.

Non-Surgical Treatment for Overactive Thyroid and Weight Gain

While healthcare providers are aware that weight gain may arise after treatment, they often do not mention this outcome to patients, Dr. Boelaert says.

The usual progression, Dr. Boelaert says, is this: patients notice they are losing weight without trying and go to the doctor, at which time they learn they have an overactive thyroid. They undergo treated with antithyroid drugs or with medication plus radioactive iodine treatment (RAI).

Following treatment for hyperthyroidism, patients will observe a steady weight gain despite not changes in their eating or exercise. First, the weight will approach their normal level but then many continue experience further weight gain, reaching overweight or even obesity. As such, Dr. Boelaert set out to evaluate out just how severe the weight gain issue is in patients treated for hyperthyroidism, and what might explain this problematic result.

With Hyperthyroidism, Weight Loss than Weight Regain is Common

The researchers turned to the Thyroid Clinic Database at the University Hospitals Birmingham National Health Service Foundation Trust to gather data on all adult patients with hyperthyroidism treated either with antithyroid drugs, radioiodine (131-I), or both. Information was collected for patients treated between 2000 and 2014 with three years of followup.¹None of the patients had a thyroidectomy—surgical removeal of the thyroid—which is another treatment option.

In all, there were 1,373 patients, ages 18 to 90 years, who were evaluated, and their weight was tracked over time. During treatment, the men, in general, gain about 17.6 pounds while the women gained a little over 12 pounds. The researchers compared the patients’ weight gain with that of a matched comparison population of nearly 11,000 people who did not have an overactive thyroid.¹

At the start of drug treatment, those who were diagnosed as having an overactive thyroid weighed less, on average than the comparison population, Dr. Boelaert says, which was expected. However, after treatment, the patients with hyperthyroidism were more likely than the comparison group to reach a level of obesity. In effect, men were 1.7 times more likely and women, 1.3 times more likely, to gain enough weight to be considered in the obese range.¹

When compared with drugs alone, treatment that included RAI was linked with an additional gain of about 1.3 pounds. (This is included in the overall gain found, as that figure looked at all patients, with all three treatment plans, and averaged the gain).¹

“Experiencing steady weight gain is the most prevalent during the first six months,” after treatment, Dr. Boelaert tells EndocrineWeb, and then it may taper off somewhat. But some level of weight gain was experienced by most pateints for more than 24 months.¹

From the point at which the patients sought care to the end of their treatment followup, an increased in weight of 5% or more was measured in 65% of patients with hyperthyroidism, and more than one iin three (38%) experienced a weight gain of 10% or more over their usual body weight.¹

Men gained more than women and those with overactive thyroid due to Graves’ disease were more likely to gain more weight than those who had toxic nodular hyperthyroidism or those whose cause of overactive thyroid was not known.¹

What Is Causing Weight Gain after Antithyroid Drug Therapy?

Dr. Boelaert still can’t say for sure why individuals who are treated with antithyroid drugs to reverse their hyperthyroidism show a tendency to gain back the lost weight plus more. “It appears something in the disease process or perhaps from the treatment makes them end up heavier.” Clearly, more research is needed for us to understand the specific mechanisms behind the shift upward in body weight as a result of non-surgical treatment for overactive thyroid, she says.

Also, we know that appetite signals get disturbed when the thyroid goes out of whack, she says. When patients come in for treatment, ”lots of patients say, ‘I am losing weight although I feel like am eating like a horse.'” After the antithyroid treatment begins, at least some people may continue to eat the same larger amounts that they have grown accustomed to, and this may contribute to the weight gain, she says.

Do appetite signals return to normal once treatment begin? “We don’t know, but we hope to study this,” Dr. Boelaert says.

She worries about the adverse effects that are associated with overweight. “People with an overactive thyroid already have an increased risk of cardiovascular disease,” she explains. “If they then become overweight or obese, that is a further ‘hit.”’ So recognizing your increased risk for heart disease, and concerns about weight gain should be discussed with your doctor, and incorporated into your treatment plan.

Address Weight Gain from Antithyroid Drug Therapy

The new research is providing some valuable new information, says Reshmi Srinath, MD, director of the Mount Sinai Weight and Metabolism Management Program ,and assistant professor of endocrinology, diabetes, and bone disease at the Icahn School of Medicine in New York City; she reviewed the findings but was not involved in the research.

“It puts some numbers on a phenomenon that we have observed but haven’t been able to quantify,” she says of the average weight gains found among the men and women in the study.

My patients with overactive thyroid, Dr. Srinath says, are often delighted at the initial weight loss but she cautions about the chance that this trend will reverse. Knowing that weight gain is likely once the drug treatment begins to normalize the thyroid function, and that weight gain may ”overshoot” resulting in unwanted excess body weight is a key point of care to be addressed.

When she sees patients, she makes it a point to warn them of the possibility of weight gain and urges them to make necessary adjustments to their diet and especially to get regular physical activity as the best way to counter the potential for weight to creep up.

It’s also very important, she says, to be closely monitored while you are under treatment. Particularly in the first 18 months, patients should be in contact with your health care team every three months, for services such as lab testing, to keep an eye on the thyroid function, which requires monitoring thyroid function levels. “We want to avoid extreme fluctuations in thyroid hormone levels, which—if out of range—could accellerate the tendency to experience weight gain,” Dr. Srinath says.

Frank Discussion about Weight Changes and Heart Disease Risk Needed

Awareness of the tendency for weight gain is the first crucial step for every patient with hyperthyroidism, Dr. Boelaert says. She says doctors should be more forthcoming about the probability of weight gain but that patients should be prepared to discuss it and insist it become part of your care plan.

“I tell patients, ‘When I make you better, I expect that you will gain weight. The evidence is that probably you will gain more than you lost.” So know this, and advocate for clear guidance on what you can change to slow any inevitable weight gain and to prevent exceeding your usual, healthy weight.

Dr. Boelaert found slightly more higher net weight gain in her patients who had radioactive iodine therapy than drugs alone, but she doesn’t think this side effect should not steer people away from having RAI treatment since the cure is much higher with this treatment, she says.

She notices that the patients who do adopt a healthier lifestyle, if they weren’t already following a heart healthy diet and getting daily physical activity, when she first met them, can curtail the otherwise likely excess weight gain.

“Having an overactive thyroid is not a benign disease,” she tells her patients. Treatment is crucial and so is keeping an eye on your weight as the treatment process progresses.

Neither Dr. Boelaert nor Dr. Srinath have any disclosures.

Last updated on 06/01/2020

5 Foods that May Help Ease Hyperthyroidism Symptoms

The Best Thyroid Medication for Weight Loss

Thyroid & Weight Gain

Thyroid patients often struggle with their weight.

If you are reading this, and you have low thyroid or hypothyroidism, then you probably know what I am talking about.

Your thyroid is one of the primary regulators of your metabolism.

This is why people who have low thyroid or hypothyroidism end up gaining weight.

Low thyroid leads to a lower than normal metabolism which ultimately results in weight gain.

But why is it that so many thyroid patients continue to stay overweight DESPITE taking thyroid medication?

And why is it that so many thyroid patients continue to experience low thyroid symptoms DESPITE taking thyroid medication?

The answer to both of these questions is basically the same and it has to do with the type of medication they are taking.

The truth is that some thyroid medications are better than others when it comes to losing weight and helping you to feel better.

And that’s exactly what we are going to talk about today.

The Best Thyroid Medication for Weight Loss?

Is there a “best” thyroid medication for weight loss?

One that stands above the others and one that you can reliably count on to help you lose weight when you take it?

Unfortunately, the answer to that question is no.

But, there is definitely a class of thyroid medications which can give you a much higher chance of success in your weight loss efforts.

And these medications work because they are much more powerful than standard thyroid medications.

Which medications am I talking about?

Any thyroid medication which contains the active T3 thyroid hormone.

T3 thyroid hormone is the most powerful thyroid hormone in your body and it’s the one that you want to take if you are having issues with weight with low thyroid.

How do you get T3?

Fairly easy, actually.

It’s just a thyroid hormone and it’s found in several types of thyroid medications.

The most potent include:

T3 differs from T4 thyroid hormone medications like levothyroxine and Synthroid because it is active immediately upon absorption.

Medications like levothyroxine must be activated before they can be used by the body.

And this seems to make all of the difference in many thyroid patients.

And I’m not the only one to suggest that T3 thyroid medications are superior when it comes to weight loss.

We also have several studies which show that thyroid patients who switch to NDT medication (like Armour thyroid) lose weight even when switching from levothyroxine (1).

It’s important to note that this weight loss occurred without changing diet or exercise routines, as well.

In addition to these studies, we also have data directly reported from thyroid patients which shows that they prefer thyroid medications with T3 in them compared to those with T4 only.

A survey of over 12,000 thyroid patients illustrated this point perfectly.

Thyroid patients taking NDT and T4/T3 combinations had fewer weight issues compared to those taking levothyroxine and Synthroid.

It’s pretty clear that if weight loss is your goal you should be taking a thyroid medication which contains T3.

Understanding Dose

This is one huge area for confusion for many thyroid patients, so let me take some time to clear it up.

I frequently hear thyroid patients complain that “X” or “Y” thyroid medication didn’t help them lose weight.

This is true of even the most powerful thyroid medications which contain T3 thyroid hormone!

But there’s one big problem with these statements…

You cannot tell whether a thyroid medication is effective or not unless you first know that you were dosed CORRECTLY!

Let me explain…

Imagine you have two people who are both taking the same thyroid medication but at different doses.

Person A is taking liothyronine at a dose of 5 mcg per day along with her levothyroxine at 75mcg.

This person is still struggling with low thyroid symptoms and weight gain even while taking T3 and T4 thyroid hormones.

Person B is taking liothyronine at a dose of 15mcg per day along with her levothyroxine at 50mcg per day.

This person is feeling better and has lost 10 pounds while this combination of medications.

When all is said and done, person A claims emphatically that liothyronine is a failure and does not help with weight loss while, on the other hand, person B claims that liothyronine is an amazing weight loss medication and has helped her lose 10 pounds without changing her diet or exercise routine.

Both people have the exact opposite experience despite taking the exact same thyroid medication.

But there’s a big difference between the two of them, right?

Person A is taking 1/3 of the dose that Person B is taking of the SAME thyroid medication!

And this is a perfect example of how dose plays a HUGE role in how well you feel.

I often will see thyroid patients make sweeping claims and generalizations about thyroid medications without saying ANYTHING about dose!

And you simply cannot make assertions about any thyroid medication without first talking about the dose.

So don’t fall into this trap!

If you want your thyroid medication to work you have to be on the RIGHT type of thyroid medication AND the right dose.

Taking Too Much isn’t the Answer

Another trap I see thyroid patients fall into is what I will call the “more, more, more” trap.

If the answer to my weight problem isn’t solved by my current thyroid medication or dose then the answer MUST be simply taking more of the same thing but at a higher dose.

The theory here is that if you can push yourself into a hyperthyroid state then you will lose weight, right?

You would think so, and maybe hope so, but it isn’t really true in practice.

Not only is taking too much thyroid medication dangerous, it’s also not likely to help you lose any weight.

This is also why you do NOT want to use thyroid medication to aid with weight loss if you don’t have a thyroid problem!

Why is this?

Most thyroid medications that people take contain only the T4 thyroid hormone.

Medications like levothyroxine and Synthroid fall into this category.

These medications, while they can be effective for some, often fail to help many people (as many as 20%) feel better.

It has been shown that these medications can readily be converted into the inactive thyroid hormone metabolite known as reverse T3.

And if your body takes levothyroxine and turns it into rT3 instead of T3 then your symptoms and weight gain can often get worse.

This process can occur due to something called thyroid conversion and it’s something that you should be familiar with as a thyroid patient.

Thyroid conversion is the process by which your body takes and either activates or inactivates the thyroid hormone that you are taking by mouth.

Bottom line:

Don’t think you can just increase your dose to help you lose weight.

In fact, taking a high dose is not only dangerous but it might cause you to gain weight through reverse T3 conversion.

Reasons you aren’t losing weight on your Thyroid Medication

You should also be aware that it is possible to lose weight with whatever thyroid medication you are taking.

In my experience in treating thyroid patients for 5+ years, here are a few of the most common reasons that thyroid patients aren’t losing weight…

#1. You Need T3

There are just some people out there who will need T3 thyroid hormone in some form no matter what.

Most doctors like to believe that everyone is fine taking a T4 only thyroid medication like levothyroxine but that just isn’t the case.

We know from studies that approximately 20% of the population has a problem utilizing levothyroxine to its fullest.

And if you are one of the unlucky few then you will probably need to add T3 thyroid hormone to your regimen in some form.

You can do this simply by switching up your thyroid medication but it will require a new prescription from your doctor.

Talk to your doctor about doing this, but be sure to discuss dosing to ensure that you are not only on the right medication but also the right dose.

#2. You aren’t absorbing your medication

You also need to be aware of absorption issues with your current thyroid medication.

Thyroid medication, in general, is quite the fickle medication.

Do you remember your doctor or pharmacist telling you to avoid taking your thyroid medication with any food?

Absorption issues are the problem.

Your thyroid medication will look for basically any reason to not make it into your bloodstream through your intestinal tract.

Before you jump to another medication, make sure you are actually absorbing whatever thyroid medication you are taking now.

Avoid taking your thyroid medication with food, coffee, various drinks, and even supplements as all of these things can negatively impact absorption.

You can also try switching to cleaner thyroid medications which are easier to absorb, such as Tirosint.

#3. Your dose is not quite right.

Lastly, don’t blame your thyroid medication if you can’t lose weight until you optimize your dose!

Optimizing your dose includes basing your dose off of more than just your TSH.

You should also be looking at your free thyroid hormone lab tests such as free T3 and free T4.

You might be on a dose of thyroid medication which puts your TSH in the sweet spot but is not high enough to increase your free T3 and free T4.

If this happens you simply won’t feel better or be able to lose weight.

Final Thoughts

If you are a low thyroid patient struggling to lose weight and you are looking for some help from your thyroid medication make sure you follow these rules!

#1. Make sure that that your thyroid medication is being absorbed properly.

#2. Make sure that your dose is optimized and high enough for your body.

#3. Consider taking T3 thyroid hormone medication in some form (any type will do).

#4. Check your lab tests to make sure your free T3 and free T4 are in the right range!

By following these steps you should be able to finally lose weight and start to feel better.

Now I want to hear from you:

Are you currently struggling to lose weight?

What thyroid medication are you taking right now? Do you think it’s helping or hurting you?

Are you taking a medication which contains T3 right now? If so, have you noticed a difference?

Leave your questions or comments below!

The Role of Your Thyroid in Metabolism and Weight Control

By Jacqueline Jacques, ND

Winter 2009

For a PDF version of this article, please click here.

I cannot count the times I have had a patient with weight gain come into my office certain they have thyroid disease. The conversation often starts like this, “I have had tests before, and they have been normal, but I have read all about low thyroid and I am sure mine must be low…”

Sometimes it is, and sometimes it isn’t. In this article, we will review what the thyroid gland is, its role in metabolism and what happens when it malfunctions.

What is the thyroid gland?

Your endocrine system is a group of glands in your body (such as the pituitary, thyroid, pancreas, ovaries and testes) that secrete hormones (like growth hormone, thyroid hormone, insulin, estrogen and testosterone) that regulate functions such as metabolism, growth, development and reproduction.

The thyroid gland is the largest gland in the endocrine system. It is a butterfly-shaped organ that sits roughly in the middle of the neck, just below where the Adam’s apple is in men. In your physical exam, when your doctor places a hand on the front of your neck and asks you to swallow, they are doing so to feel your thyroid gland.

What does the thyroid gland do?

The thyroid gland produces three hormones: Thyroxine (T4), Triiodothyronine (T3) and Calcitonin. T4 and T3 are what most people think of as “thyroid hormones.” These hormones play a significant role in your metabolism and in energy regulation in the body. T4 and T3 are made in the thyroid gland from using the building blocks iodine (a trace mineral) and tyrosine (an amino acid). T3 has three molecules of iodine, and T4 has four. You make about four times the amount of T4 as you do T3.

After T4 and T3 are made, they are released by the thyroid gland into circulation. This release happens in response to stimulus from a part of your brain called the pituitary that makes a substance called Thyroid Releasing Hormone (TRH). TRH tells the thyroid gland to release thyroid hormones into your blood stream.

Thyroid hormones act on almost every kind of cell in your body to increase cellular activity or metabolism. If there is too much or too little thyroid hormone, the metabolism of your entire body is impacted.

Calcitonin, which this article will not focus on, is a hormone that reduces the amount of calcium and phosphate in the blood and promotes the formation of bone by signaling the body to absorb more calcium into the bone matrix.

Diseases of the thyroid

There are numerous things that can go wrong with the thyroid gland, but mostly they fall into three categories:

Overactivity or Hyperthyroidism – when the body makes too many of the thyroid hormones
Underactivity or Hypothyroidism – when the body makes too little of the thyroid hormones
Growths – this can include benign cysts, nodules or cancers of the thyroid gland

Thyroid disease is extremely common. According to the American Association of Clinical Endocrinologists, 27 million Americans have an over or underactive thyroid gland. Thyroid disease is much more common in women – 8 in 10 thyroid patients are female and women are between five and eight times more likely than men to develop a problem with the gland. One part of this gender imbalance is the strong tie between pregnancy and thyroid disease. Approximately 18 percent of pregnant women will develop a post-partum thyroid problem. In a quarter of these, the problem will be permanent.

Thyroid disease is also strongly linked to diabetes. People with diabetes and their close relatives are approximately three to five times more likely to develop thyroid disease as compared to the general population.

Hypothyroidism, metabolism and obesity

Because the thyroid hormones T3 and T4 control cellular metabolism throughout the body, when there is not enough of them for any reason, this metabolic function slows and becomes impaired. The most common causes of hypothyroidism are autoimmune failure (Hashimoto’s Thyroiditis) and surgical removal or destruction of the gland. These latter treatments are usually done for thyroid cancer to treat hyperthyoidism or goiter (an enlargement of the thyroid gland). Outside of the United States, hypothyroidism is often caused by iodine deficiency. When there is not enough iodine to make thyroid hormones, the body cannot produce them. Iodine is added to salt in the US, which has eliminated almost all iodine deficiency.

Since thyroid hormone are important to all the cells of the body, symptoms can appear very general and may often be seen as vague in mild cases.

Signs and symptoms of hypothyroidism (underactive thyroid) include:

Fatigue
Sleepiness
Mood swings
Forgetfulness
Weight gain
Depression/irritability
Muscle cramping and aching
Weakness
Decreased perspiration
Changes in blood pressure
High cholesterol
Swelling in legs
Blurred vision
Cold intolerance
Hoarse voice
Heavy menses
Coarse, dry hair and skin
Hair loss (on head and/or body)
Constipation

How is thyroid disease linked to weight and BMI?

While weight gain or difficulty losing weight is strongly associated with hypothyroidism, the connection with body mass index (BMI) and obesity is still not well understood. Several new studies have examined this and we are beginning to gain more knowledge.

A study published in the International Journal of Obesity in 2006 compared BMI and TSH levels in 6,164 adults from 1995 to 2001i. In this study, higher BMI was associated with higher TSH (TSH is higher in hypothyroidism), and increases in BMI throughout the six-year period was positively correlated with increases in TSH. In a 2004 study of patients with obesity referred for evaluation at a sleep disorder clinic found previously undiagnosed subclinical hypothyroidism in 11.5 percent of patients ii. They also found a strong correlation with BMI and neck circumference.

In a group of 72 patients preparing for gastric bypass surgery, 25 percent were found to have undiagnosed subclinical hypothyroidismiii. They concluded that overall, morbid obesity was associated with elevated TSH and that weight-loss after surgery generally resulted in decreasing TSH. It is important to note that this study, however, did not find a direct association between TSH and BMI.

Several studies have found changes in TSH in obesity with normal levels of T4 and T3iv,v. This has lead some researchers to believe that there is another cause of the elevation of TSH that is not related to low levels of circulating thyroid hormones. Currently, a popular theory is that insulin resistance leads to changes in the thyroid that can result in changes in the gland and possibly in TSH levels of thyroid hormone levelsvi. Other things being examined are associations with leptin and adiponectin.

How do I get my thyroid checked?

There is enough evidence for undiagnosed thyroid disease in obesity, that if you have excess weight or obesity, it is probably a good idea to have your thyroid checked with your annual labs. This is even truer if you are female or know that you have insulin resistance or diabetes, because of the increased risk. The most common tests used to evaluate the thyroid are:

TSH: TSH is the most common screening test for thyroid disease. Levels of TSH rise when levels of thyroid hormone decrease. What constitutes “normal TSH” has been much debated in the past decade. While the most recent consensus statement issued by a joint committee of the American Association of Clinical Endocrinologists (AACE), the American Thyroid Association (ATA) and the Endocrine Society (TES) stated that the upper limit of TSH should be 4.5 mIU/L, the AACE issued their own follow-up statement saying that “AACE uses an upper limit of normal for TSH of 3.0mIU/L established in a population of patients carefully screened for thyroid disease by the National Academy of Biochemistry in 2002.” Thus, if you have a TSH that is between 3 and 4.5, you may want to ask your doctor about repeat testing or further tests to explore for thyroid disease.
T3 and T4 levels: T3 and T4 are your circulating thyroid hormones. These may be checked on an initial screen or only if TSH is found to be abnormal. These tests should be done using a method called radioimmunoassay (RIA).
Thyroid antibodies: As Autoimmune destruction of the thyroid gland is the most common cause of hypothyroidism, sometimes your doctor will look at antibody levels. These include thyroid peroxidase antibody (TPO), thyroglobulin antibody (TgAb) and thyroid stimulating hormone receptor antibody (TRAb).
Other tests: Other tests that your doctor may use to look at your thyroid function include: TRH (thyroid releasing hormone), thyroid ultrasound and thyroid scan (radioactive iodine uptake test).

To learn more about thyroid disease, you can talk to your doctor or visit the following Web sites for more information:

About the Author:
Jacqueline Jacques, ND, is a Naturopathic Doctor with more than a decade of expertise in medical nutrition. She is the Chief Science Officer for Catalina Lifesciences LLC, a company dedicated to providing the best of nutritional care to weight-loss surgery patients. Her greatest love is empowering patients to better their own health. Dr. Jacques is a member of the OAC National Board of Directors.

References:
i Nyrnes A, Jorde R, Sundsfjord J. Serum TSH is positively associated with BMI. International Journal of Obesity (2006) 30, 100–105
ii Resta O, Pannacciulli N, Di Gioia G, Stefàno A, Barbaro MP, De Pergola G. High prevalence of previously unknown subclinical hypothyroidism in obese patients referred to a sleep clinic for sleep disordered breathing. Nutr Metab Cardiovasc Dis. 2004 Oct;14(5):248-53.
iii Moulin de Moraes CM, Mancini MC, de Melo ME, Figueiredo DA, Villares SM, Rascovski A, Zilberstein B, Halpern A. Prevalence of subclinical hypothyroidism in a morbidly obese population and improvement after weight loss induced by Roux-en-Y gastric bypass. Obes Surg. 2005 Oct;15(9):1287-91.
iv Bastemir M, Akin F, Alkis E, Kaptanoglu B. Obesity is associated with increased serum TSH level, independent of thyroid function. Swiss Med Wkly 2007;137:431–434
v Marina A. Michalaki, Apostolos G. Vagenakis, Aggeliki S. Leonardou, Marianna N. Argentou, Ioannis G. Habeos, Maria G. Makri, Agathoklis I. Psyrogiannis, Fotis E. Kalfarentzos, Venetsana E. Kyriazopoulou. Thyroid. January 1, 2006, 16(1): 73-78.
vi Rezzonico J, Rezzonico M, Pusiol E, Pitoia F, Niepomniszcze H. Introducing the thyroid gland as another victim of the insulin resistance syndrome. Thyroid. 2008 Apr;18(4):461-4.

90,000 is it possible to lose weight with hypothyroidism

You reduce your portions of food almost every day, and your weight grows. You cook your own chicken breast and nibble on raw carrots, pork and butter, you are even afraid to sniff, and the weight grows. You sweat in the gym and walk up to the twelfth floor every day, and the weight continues to grow. It may be time to check your thyroid function.

Thyroid gland work

This small butterfly-shaped gland, wrapped around the front of the neck, manages to influence the functioning of the entire body by producing a number of neurotransmitters – chemicals through which communication between nerve cells, as well as between nerves and muscle cells, is carried out.In particular, these are dopamine, serotonin, adrenaline and norepinephrine. About a third of all depressive conditions are associated with a malfunction of the thyroid gland: if it is not active enough, the adrenal glands try to hedge it by releasing an increased amount of adrenaline and cortisol into the bloodstream. As a result, a person feels both stressed and tired at the same time.

The main function of the thyroid gland is the production of thyroxine, a hormone that activates our metabolism. As soon as this gland, for one reason or another, ceases to adequately cope with its direct responsibilities, the so-called subclinical hypothyroidism makes itself felt.Its main symptoms are as follows: you constantly want to wrap yourself up warmly, while those around you are by no means cold; your skin dries up, and no moisturizing creams can cope with this dryness; you are overcome by chronic fatigue that does not go away even over a long weekend; your body temperature is slightly below normal. If you are a man, problems with potency may begin, hypothyroidism in women often leads to the fact that menstruation now and then comes at the wrong time. Hair may begin to fall out, muscles sometimes cramp.And also – you gain weight, even eating only lettuce leaves. The thyroid gland and excess weight may be related; hypothyroidism and obesity often go side by side.

Mimic disease

Fatigue and drowsiness are signs of hypothyroidism

Hypothyroidism is insidious in that it sometimes very successfully disguises itself as a number of other diseases, as well as temporary malfunctions in the work of an absolutely healthy organism. The fact is that if the thyroid gland malfunctions, almost all metabolic processes are disrupted.With the same symptoms, it is easy to suspect you have heart problems, and problems with the nervous system, and a disease of the gastrointestinal tract; you may decide that your kidneys are just chilled, that your liver is playing naughty again, that you are trite to be nervous about blockages at work. Sometimes people suffering from hypothyroidism go from one specialist to another for months, or even years, trying to understand what is wrong with them, why no treatment helps, why, despite any efforts, excess weight does not go away.If this is about you, it’s time to make an appointment with an endocrinologist. Your doctor will prescribe a number of tests for you, in particular, to determine the level of TSH (thyroid-stimulating hormone of the pituitary gland) in the blood. Laboratory diagnosis of hypothyroidism is highly reliable; if the test results confirm the diagnosis, substitution therapy will be your salvation – the constant intake of the hormone thyroxine, the production of which your thyroid gland has ceased to cope with.

Legends about iodine and not only

Unfortunately, in recent years there has been a misconception that iodine, more precisely, iodine-containing preparations, can cope with insufficient activity of the thyroid gland.However, things are not so simple. Yes, the body needs iodine; Yes, with hypothyroidism, its content in the blood falls – but having purchased drugs that compensate for iodine deficiency, the disease cannot be defeated. The problem is that with an insufficient amount of thyroxine, our body simply stops assimilating iodine. Therefore, it makes sense to take all kinds of supplements containing iodine only as part of complex drug therapy.

Hormonal treatment, sadly, is also surrounded by myths and legends.It’s the twenty-first century, and many people still believe that “hormones are dangerous.” And even that “they get fat from hormones.” In fact, it is not the hormones themselves that are dangerous, but the hormonal imbalance, including the one that leads to hypothyroidism. It is with this imbalance that preparations containing thyroxine are designed to cope. Yes, they will have to be taken for a long time, and in some cases, for example, when hypothyroidism is caused by an autoimmune disease, lifelong hormone replacement therapy is also indicated. But in the end, it is the hormones that will help you lead a full life – and yes, finally get rid of such an unpleasant symptom as obesity with hypothyroidism.

Women at risk

Unfortunately, thyroid disorders can occur at any age and in people of both sexes. However, the most vulnerable group of the population is young mothers: they are often trapped by such an unpleasant condition as postpartum thyroiditis.

During pregnancy, a woman’s immune system is temporarily deactivated; this is necessary so that antibodies and immune cells do not begin to attack the placenta, considering it a foreign element. Accordingly, immediately after the birth of the baby, the maternal immunity is again actively involved in the work.In some cases – even too actively, mistakenly attacking harmless thyroid tissue and destroying them. This is how postpartum thyroiditis occurs – an autoimmune inflammation of the thyroid gland. At first, the amount of hormones produced by the thyroid gland jumps sharply, and the young mother has symptoms of hyperthyroidism – increased irritability, fussiness, rapid pulse, subfebrile (slightly elevated, not higher than 37.5 degrees) temperature, sudden mood swings and even weight loss at normal or enhanced nutrition.And then comes the phase of hypothyroidism: absent-mindedness, memory impairment, constant exhausting weakness, swelling – and steadily growing weight.

Good news: 80% of new mothers suffering from postpartum thyroiditis get rid of it safely – of course, with proper treatment, which was started on time. Not too good news: the remaining 20% of women have to put up with thyroiditis for their entire lives. The latter, however, is not a catastrophe: at the current level of development of medicine, life with thyroiditis may well be active and happy.

At the slightest suspicion that your mood and weight jumps are outside the normal range, you need to make an appointment with a gynecologist-endocrinologist or just an endocrinologist. Yes, while you are breastfeeding, hormone replacement therapy is not advisable – but as soon as you stop breastfeeding, your doctor will select the drugs you need.

Another period when women are at risk of developing thyroid imbalance is menopause. The problem is that it is very easy to confuse the symptoms of age-related changes in the body with the symptoms of hyper- or hypothyroidism, especially without being a doctor.If you are a lady of an interesting age, and menopause bothers you more than your peers, it is better to play it safe and visit an endocrinologist.

Hypothyroidism in children

Unfortunately, thyroid malfunction occurs even at a tender age. Congenital hypothyroidism usually manifests itself as follows: the child is born rather large (more than four kilograms), looks edematous, his umbilical wound does not heal for a long time and the jaundice of newborns does not go away.Growing up, such a baby is abnormally calm: he sleeps a lot, reacts sluggishly to stimuli, rarely stains the diapers due to a sluggishly working intestine. At first, parents are happy that their “hero” is growing by leaps and bounds and is a little trouble, but if the diagnosis is not made on time, there will be few reasons for joy. The later the treatment of congenital hypothyroidism is started, the more severe the consequences for the physical and intellectual development of the child will be.

Newborns must be tested for hypothyroidism

Fortunately, today in domestic maternity hospitals, all babies are mandatory checked for a number of congenital diseases, including hypothyroidism.On the third or fifth day after birth, blood is taken from the child’s heel and checked for TSH levels, and the parents are certainly informed of the abnormal results. If hormone replacement therapy is started in the first month of a baby’s life, then there is every chance to prevent developmental delays.

Editorial opinion

You turned to a neuropsychiatrist about a depressive state, but the drugs prescribed by him do not help? It is worth checking with an endocrinologist.With dysfunction of the thyroid gland, antidepressants do not give an effect – you need to adjust the hormonal background.

90,000 Full life Excess weight can be a consequence of a disease. How to identify it: Lenta.ru

Treat yourself and your body with respect, love your figure, despite being overweight – all this is worthy of all praise. However, being overweight is a serious danger to your body, which cannot be ignored. Lenta.ru with the support of Berlin-Chemie / A.Menarini explains what plays an important role in effective weight loss.

There are frequent stories when grueling sports programs and strict diets do not lead to the expected result. Weight may decrease, but not comparable to the expended forces. Difficulties with reduced or, conversely, increased body weight can be symptoms of a serious illness that affects about eight million women in Russia. Excess weight is not always a consequence of a high-calorie diet. The fault of “fullness” may be a disease, namely, disorders in the thyroid gland, a decrease in its function.

In Russia, hypofunction of the thyroid gland is quite common. However, its diagnosis is fraught with difficulties, because the manifestations of hypothyroidism are nonspecific and can often be regarded by specialists as a consequence of stress and lifestyle, so the disease is not immediately detected.

Biologically active substances produced by the gland – thyroxine and triiodothyronine – “control” the basal metabolism in the human body. As a result, with a lack of these hormones, all metabolic functions decrease, including water balance, which leads to the accumulation of fluid and manifests itself in the form of edema of the upper and lower extremities, as well as the facial area.In this connection, the extreme stage of hypothyroidism is called myxedema, which translates as “mucous edema”.

– Autoimmune thyroiditis. This is a disease in which, for as yet unexplained reasons, the cells of the immune system perceive thyroid tissue as foreign and begin to “fight” against it. As a result, the work of the thyroid gland is disrupted.

– Pregnancy. During this period, significant hormonal changes are observed in the woman’s body, which can lead to disruption of the thyroid gland and, consequently, to a decrease in the amount of its hormones.

– Surgery performed on the thyroid gland can also cause disruption of its work.

Symptoms of hypothyroidism are varied and are expressed not only in excess weight. The thyroid gland is responsible for the entire basic metabolism in the body, therefore, disturbances in its work will affect all systems.

Hypofunction of the thyroid gland is often not diagnosed in time, despite the variety of manifestations. Although only one study is needed to confirm the diagnosis – a blood test for the content of thyroid-stimulating hormone (TSH).After 35 years of age, it is recommended to conduct this study once every five years.

TSH is responsible for the work of the thyroid gland, since it is he who controls the required concentration of thyroid hormones. Therefore, when studying the functions of the gland, its content in the blood is of primary importance. It is not difficult to carry out such an analysis, since it is performed in any laboratory. In case of violations, it is necessary to contact an endocrinologist. When hypothyroidism is confirmed, hormone replacement therapy is performed.The selection of the optimal doses of the drug prevents the onset of symptoms of hypofunction. Correctly prescribed therapy returns patients to their usual way of life.

Thus, hypothyroidism is a decrease in thyroid function, which is most common in women. The disease is diagnosed out of time due to the variety of manifestations. However, thanks to a simple study, a blood test for TSH, it is not difficult to identify this disease and prescribe the necessary treatment, while health, weight and appearance will return to normal.

Find out where to get tested.

When “plus” is “minus”: excess weight and thyroid gland

Diseases of the thyroid gland have been known for a long time and are often visible to the “naked” eye. Famous thinkers, scientists and doctors of ancient China, Egypt, India, Greece and Rome, who lived before our era, described “tumors” of the neck, knew about the consequences of these diseases and tried to treat them. And Napoleon, choosing a soldier, carefully examined the neck of the applicants.

The thyroid gland is the “commander” of all metabolic processes.Its hormones normally help the body adapt to its environment by speeding up or slowing down its metabolism. And disorders of organ function invariably affect the appearance, weight, psyche and well-being.

About prohormones and true hormones

Tetra- and triiodothyronine, also known as T4 (thyroxine) and T3, are synthesized in the gland with the participation of iodine. At the same time, T4 can be considered a prohormone, due to its low biological activity. While T3 is a “true” hormone, and all known “thyroid” effects are associated precisely with its action.The conversion of T4 to T3 occurs directly in the cells and with the participation of selenium. Therefore, a deficiency of this trace element can provoke symptoms of “hypothyroidism” at a normal level of T4.

T3 cells have the most “profound” influence, “working” directly with the genetic apparatus of mitochondria and stimulating:

synthesis or breakdown of proteins throughout the body,
breakdown or accumulation of glucose and fats,
strengthening or weakening thermal products,
deterioration or improvement of thought processes
and many other effects.

Many articles have been written about the functions of thyroid hormones, but this one will only talk about carbohydrate metabolism.

About “sugar” and the thyroid gland

Glucose is the main and highest quality source of “fuel” for the body, a kind of “95th gasoline”. The spark for “ignition” of which is oxygen.

Normally, with the participation of insulin, glucose from the blood enters the cells, where it is used for energy production. Residual glucose is deposited in the liver and skeletal muscle as glycogen, as a “local fuel source”.If too much glucose is supplied, part of it is converted into fat and stored in case of energy deficiency.

T3 in this direction:

stimulates intestinal glucose absorption,
improves glucose uptake by cells,
potentiates the action of insulin, making it easier for glucose to enter the cell,
promotes energy production,
and also stimulates cellular respiration.

Deficiency of thyroid hormones disrupts the utilization of glucose by cells, contributing to its deposition into fats.They say about such people: “I breathed next to the candy – and recovered.” And diet and exercise have no effect.

An excess of T4, T3 – on the contrary, leads to unmotivated weight loss and rapid exhaustion.

Among other things, an imbalance of thyroid hormones provokes the development of diabetes mellitus. And if earlier it was thought that this is only important for type 1 diabetes (insulin-dependent), then more recently, we are talking about type 2 diabetes as well.

It should be noted that metabolic disorders appear already in the subclinical course of the disease (when the level of hormones is slightly changed)

It is for this reason that thyroid screening is recommended, even in the absence of a vivid clinical picture.

Diagnostics

Examination of the thyroid gland necessarily includes an assessment of the level of T4 and T3, as well as TSH – the controlling hormone of the pituitary gland.

Hormonal “connection” in this case occurs according to the principle of “negative feedback”, deficiency of T4 and T3 – provokes an increase in TSH.

All hormones in the blood, including T4 and T3, bind specific carrier proteins. It is not easy to get out of this “connection”, and hormones cannot exert their effect until the proteins “let go” of them.Only free fractions have effects on the body.

This feature requires an assessment of not only the general level of thyroid hormones, but the concentration of their free forms – T4w., T3w.

Of course, in addition to the presence or extent of existing violations, you can also learn about future risks. The likelihood of destruction of the thyroid gland is indicated by an increase in antibodies to thyroperoxidase (anti-TPO) and thyroglobulin (anti-TG).

Thus, an “unexplained” change in weight, in conjunction with other symptoms of “thyroid” imbalance, requires an assessment of the level in the blood:

TTG,
T4sv,
T3sv,
anti-TPO
and anti-TG.

These studies do not require special preparation and are available for delivery individually or in the format of the complex “Examination of the thyroid gland. Screening”.

Hypothyroidism and hyperthyroidism, symptoms and treatment in the Vyborgsky district of St. Petersburg

About diseases

Among the variety of thyroid diseases, hypothyroidism and hyperthyroidism are especially distinguished. These two diseases are united by the fact that they have one target of damage – the thyroid gland, and both of them are characterized by dysfunction of the production of thyroid hormones.This is where the similarities between hypothyroidism and hyperthyroidism end and the differences begin.

Hypothyroidism

Hypothyroidism – a disorder in the thyroid gland, expressed in a reduced production of its hormones. This disease affects about 6% of all inhabitants of the world. The main causes of the disease include an acute shortage of iodine in the patient’s body, as well as the consequences of the postponed autoimmune thyroiditis.

Learn more about the development of hypothyroidism in children, symptoms and treatment.

Symptoms and diagnosis of hypothyroidism

With hypothyroidism, you may experience:

lethargy and lethargy
muscle weakness
pain in muscles and joints
stiffness in movement
fragility of hair and nails
unreasonable weight gain

excessive sensitivity to cold, etc.

If these symptoms appear, we recommend that you consult an endocrinologist.

When diagnosing hypothyroidism, it is necessary to determine the level of hormones, for which the specialists of our clinic will prescribe a test for you:

general and biochemical blood test
analysis of the pituitary hormone (TSH)
analysis of total and free triiodothyronine (T3) and thyroxine (T4)
Trioxin Binding Protein Assay
Serum Cholesterol Assay.

In addition, you may be prescribed an ultrasound examination of the thyroid gland, as well as a puncture biopsy, electrocardiogram and chest x-ray.The scope of research is determined by an endocrinologist.

Treatment and prevention of hypothyroidism

Hypothyroidism is treated with preparations containing synthetic thyroid hormones. The specialists of our clinic will select the dose you need based on your level of hormones in the blood. At the same time, you must understand that you will have to take the prescribed drugs throughout your life.

As a preventive measure against hypothyroidism, you need to constantly consume iodine-containing foods: seafood, iodized salt, walnuts, etc.n. Also try to avoid stress and excessive emotional stress.

Hyperthyroidism

Hyperthyroidism – disruption of the thyroid gland, which is characterized by increased production of thyroid hormones. The main causes of the disease are diffuse toxic goiter, viral damage to the thyroid gland, and nodular goiter disease.

Symptoms of hyperthyroidism

In case of hyperthyroidism, you can observe in yourself:
hyperexcitability, irritability, causeless anxiety, sleep disturbance;
a sharp increase or decrease in appetite or refusal to eat;
a kind of “bulging of the eyeball”, lacrimation, corneal erosion;
Chronic weakness, tremors of the limbs;
reduction in body weight;
violation of the menstrual cycle;
increased sweating.

Diagnosis of hyperthyroidism

Diagnose hyperthyroidism on the basis of complaints and the appearance of the patient. Also, the specialists of our clinic in the diagnosis of the disease will rely on the results of a blood test, ultrasound, computed tomography and radioisotope scintigraphy of the thyroid gland.

Treatment of hyperthyroidism

Your treatment will be drugs that slow down the production of hormones and radioactive iodine.In combination with drug treatment, you will be prescribed a course of hydrotherapy and a special diet that includes a balanced content of proteins, fats, carbohydrates and vitamins. In exceptional cases, you may be offered surgery to remove part of the diseased gland.

Prevention of hyperthyroidism

As you know, it is better to avoid the disease than to cure it. Therefore, the prevention of hyperthyroidism includes:

proper balanced nutrition,
timely treatment of any thyroid diseases,
preventive examinations;
analyzes for the content of hormones.

For the treatment and timely detection of hyperthyroidism and hypothyroidism in St. Petersburg, you can contact our clinic. We will solve your problem together.

See also : Appointment with an endocrinologist.

Hypothyroidism: symptoms, signs, treatment – MedCom

Hypothyroidism: symptoms accompanying pathology

The initial stage of hypothyroidism passes unnoticed, and its primary signs are most often attributed to fatigue and overwork.With hypothyroidism, the following symptoms are observed:

apathy, lethargy, bouts of laziness;
drowsiness, especially during the day;
decreased response;
decreased immunity and frequent colds;
memory impairment and difficulty in assimilating new information.

Physical factors also become symptoms of hypothyroidism. These include swelling of the extremities, shortness of breath, sudden weight gain or weight loss, discomfort in the throat, incomprehensible pain in the chest part of the body.With hypothyroidism, a person is worried about stomach pain, digestion, belching. In women, menstrual irregularities are additional signs of hypothyroidism.

With the development of pathology, the signs of hypothyroidism become more pronounced. Patients freeze in any weather, movements become sluggish and slow, the face becomes bluish, the skin becomes dry and flaky. Another symptom of hypothyroidism is fragility and severe hair loss.

Types of disease

The classification of pathology is multifaceted and depends on many factors.Experts share several basic grades.

Primary hypothyroidism is the broadest group associated with congenital or acquired disorders of the thyroid gland. The affected gland does not produce the required amount of necessary hormones. This deficiency leads to the development of pathology.

The reasons are:

iodine deficiency;
genetic predisposition;
inflammatory processes of the gland;
congenital pathology associated with the formation and development of the thyroid gland.

Secondary – associated with dysfunction and the development of pathologies in the cells of the pituitary gland. Among the factors affecting development, there are:

90,090

head injuries;

profuse bleeding;

infectious diseases and brain tumors;

long-term use of medications that inhibit the work of the pituitary gland.

Tertiary hypothyroidism has the same features as secondary hypothyroidism.

Peripheral – a rare type of disease.With hypothyroidism in this form, the normal functioning of the thyroid gland is observed, but the hormones are not absorbed by the body.

Hypothyroidism: treatment and diagnosis

There is an opinion that treatment with folk remedies will help to defeat the pathology. However, such methods often lead to sad consequences, including death. It is worth remembering that a specialist should deal with the treatment of hypothyroidism.

Diagnosis of pathology includes a number of studies that help detect the disease, find out its form and severity.The first stage consists of examining the patient and taking anamnesis. An endocrinologist is engaged in this. He finds out the present symptoms and examines the skin, analyzes the condition of the hair, asks about the state of hearing and speech functions. An endocrinologist will need to examine and palpate the condition of the thyroid gland. Since hypothyroidism is not always characterized by an enlarged thyroid gland, additional studies are prescribed to obtain an accurate picture. Additional tests include blood donation to determine the amount of hormones contained, an ultrasound examination and a number of other diagnostic methods.Based on their results, the specialist draws up a treatment regimen. Compliance with all the prescriptions and recommendations of the doctor will help to avoid the unpleasant consequences of the disease.

Hormone therapy is considered one of the most effective methods of combating the disease. Treatment begins with a medication regimen. The dosage and amount of drugs are calculated individually, based on the degree and form of the disease. Regular medication and a preventive examination by a specialist helps to lead a fulfilling life.

Restoration of the required level of hormones in the body minimizes the risk of complications and reduces the possibility of unpleasant symptoms of pathology. In some cases, additional medications are added to the main treatment for hypothyroidism. For example, this is true for the elderly and patients with concomitant diseases.

In the treatment of hypothyroidism, vitamin therapy provides support to the body. It can be fortifying drugs and certain groups of vitamins.Also, the treatment is complemented by a special diet.

Risk groups

Men are the least susceptible to hypothyroidism. Signs of the development of pathology are a decrease in potency, inhibition of reproductive functions. Hypothyroidism is most commonly diagnosed in women. This is due to the increased sensitivity of the body to hormones. The risk increases during pregnancy, after childbirth. Hypothyroidism is caused by frequent bleeding and anemia.

The second group, prone to hypothyroidism – adolescents.During puberty, one of the symptoms of pathology is a decrease in academic performance, drowsiness, and developmental delay. For newborns, a distinction is made between congenital and acquired forms. Timely diagnosis will help to avoid complications and guarantee the full development of the child in the future.

Disease prevention

For early diagnosis of pathology, regular examinations by a specialist are required. Therefore, it is not recommended to ignore the annual visit to the endocrinologist.

A balanced diet helps to counteract hypothyroidism.The diet should be balanced and a separate iodine intake should be added if necessary. As a rule, iodine-containing drugs are prescribed based on age and region of residence.

It should be included in the diet:

seafood;

90,091 fish;

seaweed;
persimmon;
buckwheat, etc.

In general, the diet should be rich in greens and light foods. Preference should be given to steamed food, reducing the consumption of fatty and fried foods.

How to lose weight with hypothyroidism: advice from an endocrinologist – Rambler / female

The cause of excess weight in a person is often the usual overeating and unhealthy lifestyle. Endocrine diseases can also lead to obesity. It is important for overweight people to know how to lose weight with hypothyroidism.

Symptoms of hypothyroidism

The main symptoms of an insidious disease are:

Weakness, decreased performance. Memory impairment. Decreased hearing, attention.

, nail breaking, dry skin. Increase in human weight. Metabolic disease. Apathy. Violation of the rhythm of the heart.

In case of dysfunction of the thyroid gland, treatment is necessary to restore hormonal levels: a special diet, taking medications. Losing weight with hypothyroidism

Losing weight with such an ailment is possible by observing certain rules. The details of losing weight should be discussed with your doctor.

Principles of weight loss

The basic principles are:

Stimulation

metabolism

.Restoration of nutrient deficiencies. Due to iodine deficiency in the thyroid gland, hormones are not produced in the right amount. The use of a diet at the same time as physical activity and drugs. Eating often, in small doses. Eating a lot of protein. Protein is a building block for the formation of cells in the body, the amino acid tyrosine, which is the basis for the formation of hormones in the thyroid gland. Eating foods with a large amount of carbohydrates up to 16 hours, during the period of greatest mental and physical activity of a person.At this time, glucose is not deposited in fats, but all is used to restore energy.

On the advice of an endocrinologist, if symptoms of hypothyroidism are present, tests should be done to confirm the diagnosis. The diet should start only after hormones have been brought back to normal. At the same time, it is strictly forbidden to starve, you can get vitamin deficiency.

The diet is drawn up by an endocrinologist, who, along with the ordering of food, will prescribe medications. Medication normalizes hormone levels, promoting weight loss.

The basis of the diet is split meals. It is necessary to take food often and in small doses.

Recommendations of endocrinologists:

Products should contain elements that are lacking in the body. Have a positive effect on the thyroid gland, start the metabolic process. The body must be saturated in sufficient quantities with fiber, vitamins, minerals. Exclude from the diet food that disrupts the work of the thyroid gland. The number of calories consumed should be considered, but this should be a measure.You can find a calorie counting calculator on the internet.

Correctly selected diet will help:

prevent weight gain; strengthen nails; stop hair loss; correct mental state; improve mood; restore sleep; normalize the activity of the cardiovascular system.

Useful products

Advice from an endocrinologist often speaks of the dangers of fast weight loss.

In this disease, fasting days, fasting, kefir or cabbage diet, fasting are prohibited.

Attention should be paid to products containing iodine. The attending physician will tell you about the amount of this element required for the body. Excess iodine is also harmful to the thyroid gland.

These products include:

; seaweed; tomatoes; dairy products; beet; cottage cheese.

Protein basis of the diet. Quality proteins are found in the following products:

cottage cheese, cheese; liver, rabbit meat, sea fish, beef; eggs; nuts. With hypothyroidism, you can drink a couple of cups of natural, weak coffee a day, which stimulates the body to spend energy.Thus, reduce the number of calories.

Harmful products

The following foods should be excluded from the diet:

alcoholic beverages; everything is fried; marinades; sweet and rich; salting; smoked meats; polished rice; fast food; jams and preserves; sausages, sausages.

Limit the following products:

oil, caviar a lot of cholesterol; pasta is poorly digested; milk, sour cream; fried potatoes; salt.

The most effective way to lose weight is the correct diet with appropriate medication.

The disease is treated by replacing hormones missing in the body with their artificial analogs, due to which the body weight is reduced by 2-3 kg within two months of treatment.

Further weight loss should be carried out under the supervision of an endocrinologist.

Essential medicines include:

Eutirox; Levothyroxine sodium; Omega-3; L-carnitine.

In addition to hormonal treatment, patients with any stage of obesity can be prescribed Glucophage Long, which regulates metabolism.The drug reduces sugar, delays glucose absorption.

Physical activities

How to lose weight with hypothyroidism with the help of sports? Lightweight fitness will do. To build muscle, strength exercises are included in classes. As the muscles grow, the body fat will decrease.

In addition to fitness, you can go jogging, walking on stairs, jumping, bending.

Contraindications

Patients with unstable hormones should not lose weight. There will be no effect of the diet.Arrhythmia may appear, digestion will be disturbed, and the state of health will worsen. A therapeutic diet for pregnant and breastfeeding women is unacceptable. In the presence of infection, it is also forbidden to go on a strict diet.

To make it easier to lose weight, it is important to take note of the endocrinologist’s recommendations:

You should not strive to lose weight in a week. It is a lengthy but effective process. In the process of a therapeutic diet, alcohol-containing products, complex carbohydrates, and fats should be excluded from the diet. In the morning, for proper weight loss, drink weak natural coffee, which contains potassium and PP vitamins.Control your cholesterol levels. Regularly replenish the lack of iodine with seafood, walnuts, vitamin complexes. It should be remembered: the diagnosis can only be made by a qualified doctor who will prescribe the correct therapy for an insidious ailment.

It is important for people with hypothyroidism and overweight to know how to get rid of obesity, what kind of diet to apply. With an insidious ailment, the endocrinologist prescribes a special therapeutic diet. Foods containing a large amount of carbohydrates and cholesterol are excluded from the diet.The menu includes products containing iodine, proteins. Alcohol, sweets, salinity, smoked meats are prohibited. For effective weight loss, diet should be combined with physical activity. The correct diet for hypothyroidism is prescribed only by a qualified doctor.

90,000 Main causes and symptoms of hypothyroidism in women after 50 years

Peculiarities of treatment of thyroid gland hypothyroidism

Hypothyroidism is a thyroid disease that develops due to insufficient production of hormones.Hypothyroid insufficiency is not an independent disease and proceeds, as a rule, against the background of another pathology. Congenital hypothyroidism in children is especially dangerous, requiring immediate treatment. Without drug therapy, the baby may develop mental retardation and irreversible intellectual disabilities.

Main functions of thyroid hormones:

regulation of growth and full development of the body;
regulation of metabolic processes;
stimulation of the nervous system;
activation of the function of the sex and mammary glands, adrenal glands;
regulation of the immune system;
regulation of the cardiovascular system.

This disease is most susceptible to residents of large cities. This is explained by the poor environmental situation and the lack of iodine prophylaxis. Women suffer from hypothyroidism five times more often than men.

Signs of primary hypothyroidism

Primary hypothyroidism is associated with thyroid pathology, leading to inhibition of the synthesis of hormones T4 and T3, a decrease in the mass of the glandular tissue of the gland. The causes of pathology can be iodine and selenium deficiency, thyroid aplasia, tumors, uncontrolled intake of certain drugs, radiation and autoimmune disorders.Signs of primary hypothyroidism are lethargy, drowsiness, dry skin, constipation, memory impairment, and swelling. The disease belongs to the acquired subspecies.

Classification of hypothyroidism:

congenital, due to a mutation (congenital defect) of the gene responsible for the formation of the thyroid gland;
acquired, including the following subspecies: primary, secondary, peripheral, subclinical (subclinical hypothyroidism in newborns) and transient.

Clinical manifestations of hypothyroidism

Skin. The skin becomes pale and slightly yellowish, the structure of the hair is disturbed, and the puffiness of the face is observed.

Musculoskeletal system. Decreased muscle tone, severe weakness, the presence of cramps and pain in certain muscle groups. Muscle stiffness is sometimes present.

CNS. Loss of memory, hearing, visual acuity. The patient complains of numbness in the limbs. Depression and apathy.

Cardiovascular system. Chest pain, bradycardia, decreased blood pressure, enlargement of the heart.

Endocrine disorders. Adrenal dysfunction, amenorrhea, galactorrhea, decreased libido, obesity.

Our specialist will tell you more about the symptoms of hypothyroidism in women after 50 years of age at a personal appointment. You can sign up for a consultation on the Dobrobut.com website and at the above numbers. Reception is carried out by doctors with many years of experience.

Diagnosis of hypothyroidism

The diagnosis is made on the basis of anamnesis, examination of the patient and the results of clinical studies (blood biochemistry, complete blood count and tests for thyroid hormones T3, T4 and TSH). Important: the level of TSH in secondary hypothyroidism, as a rule, is lowered.

Additional examination methods include: ECG, ECHO KG (echocardiography), thyroid ultrasound and thyroid scintigraphy with radioactive iodine. In some cases, it may be necessary to consult a therapist and a cardiologist.

Postoperative hypothyroidism

This is a common diagnosis that occurs in 20% of women and 10% of men who have undergone thyroid surgery. The predisposing factors are the presence of diabetes mellitus and anemia, renal failure.

Symptoms of postoperative hypothyroidism include: disturbances in thermoregulation and metabolic processes, skin manifestations and malfunctions of the cardiovascular system, pathology of the digestive tract and muscle atrophy.

Treatment of the disease – constant intake of thyroid hormone analogues.

Treatment of hypothyroidism of the thyroid gland

Substitution therapy is carried out to eliminate the symptoms of thyroid insufficiency. The drugs are selected individually. The dosage and duration of treatment is determined by the doctor. An endocrinologist will tell you how to treat autoimmune thyroiditis (AIT) in a specific case at a personal appointment.

The most commonly prescribed drugs are sodium levothyroxine, thyroxine, triiodothyronine, and thyroidine.With the appearance of edema, the appointment of diuretics in small doses (lasex, furasemide) is justified. For severe depression, sedatives (valocardin, persen) are recommended.

Diet is essential for weight loss in hypothyroidism. Most often, such patients are shown diet number 8, which helps to restore metabolic processes. Nutritional therapy normalizes the functioning of organs and corrects weight. Nutritionists recommend fractional meals (5-6 times a day) in small portions. Foods that stimulate the production of gastric juice are removed from the diet.Legumes, garlic, onions, fatty meats, marinades and smoked meats are prohibited. In addition, it is necessary to reduce the consumption of muffins, rich broths, lard, sauces and mushrooms. Once every ten days, fasting days can be spent on juices and fruits.

Comprehensive treatment of thyroid hypothyroidism with strict adherence to all doctor’s prescriptions will help to minimize the clinical manifestations of pathology.