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Hypothyroidism and Weight Management

CSARdiverCSARdiver Member Posts: 6,256 Member Member Posts: 6,256 Member
Hypothyroidism and Weight Management

I wrote this to address misinformation/disinformation regarding what hypothyroidism is and what it is not. What is important and what is not. Be wary folks as there are a disturbing number of charlatans looking to make a profit without offering any meaningful benefit.

I had a total thyroidectomy in 2000 due to thyroid cancer. I bought into much of the bad information out there and ended up putting on ~70 lbs over the next 14 years. Despite all thoughts to the contrary - none of this was due to my thyroid, but everything to do with my transitioning from a high active military career to a cushy life in academia. I started tracking my caloric intake and output in MFP in 2014 and lost 60 lbs the first year gradually decreasing my intake and increasing my activity. I’ve been in maintenance ever since and compete in several obstacle course races and multisport races throughout the year.

Starting in 2006 I managed the pharmacovigilance profile of Synthroid (levothyroxine sodium tablets, USP). Having access to this information forced me to realize the impact thyroid has on weight management, what this influences and more importantly does not influence.

Thyroid and Hormonal Impact:

The thyroid gland is part of the endocrine system works in conjunction with the pituitary gland. The pituitary gland releases Thyroid Stimulating Hormone (TSH). The hypothalamus releases TSH Releasing Hormone (TRH).
The thyroid gland produces two primary hormones:

Triiodothyronine (T3)

Thyroxine (T4)

Symptoms of Hypothyroidism (low T3/T4):
• Sleeping disorders
• Tiredness / fatigue
• Difficulty concentrating (brain fog)
• Dry skin and hair
• Depression
• Sensitivity to cold temperature
• Frequent, heavy periods
• Joint and muscle pain

Resting Energy Expenditure (REE): the amount of energy expended by a person at rest. Basal metabolic rate (BMR) is more precisely defined as the REE measured just after awakening in the morning. In practice, REE and BMR differ by less than 10% so the terms can be used interchangeably. In testing the most extreme conditions – thyroidectomy patients off supplementation showed a similar variation to the control group ~5% shift from the mean.

What this amounts to in daily consumption is 80 kcals/day out of a 1600 kcal/day caloric budget.

Increased Cellular Uptake (Water Weight)

Any hormonal shift will result in an increase of cellular uptake – water weight. This was noted in early medicine as the increase weight noted with hypothyroidism. If hormones balance out this will trend back to normal weight after 5-7 days as long as sodium intake is fairly constant and hydration is maintained.

Note that hormones are free cycling – meaning your body mass has tremendous impact on hormonal balance. If you’re at a healthy BMI your endocrine system operates normally with little issue. If you are significantly under or overweight this causes a terminal cascade within the endocrine system – causing massive stress as glands attempt to respond to and produce hormones, continually struggling to keep up.

Testing:

When one begins to show symptoms or suspect they have a thyroid disorder the first step is a physical examination in conjunction with testing – initially TSH, but should always be followed up with a full thyroid panel.

Thyroid Panel

TSH 0.4-4.0 uU/ml (0.5-3.0 for supplemented patients) (0.2-2.0 for thyroid cancer patients)

fT3 230-619 pg/d

fT4 0.7-1.9 ng/dl

rT3 10-24 ng/dL

TRH stimulates TSH, which stimulates production of T4 and T3. T4 converts to T3 to specifically target tissues. Knowing how this works helps you identify what is going wrong in this cycle. Note that analysis takes multiple readings over time, so don’t get overly concerned with one reading. Lab errors are frequent, body changes are continual, and hormones are notoriously difficult to track and trend.

I need to add clarification on TSH and how this is often misinterpreted. The established ranges are stated above and pretty accurate (updated in 2002). What may be confusing is what feels normal to you. This is established during your adolescence and early adulthood, so whatever that number is feels “normal”. Looking back at my life I was very likely at the lower end and hyperthyroid, so this feels normal to me. I’m usually in the 0.2 currently with a dosage of 175/200 mcg alternating daily. Don’t get overly concerned with one test result out of this range though. Medical protocol should still be followed, but one high or low result should be taken in context with a full range of results.

Medication:

Hormones are incredibly powerful actors on the body – something you can see from the dosage – these are measured in micrograms and incredibly challenging to manufacture in pill form (even in pill form consistency and potency remains one of the most challenging issues). So these tablets are mostly filler.

TSH - Synthroid is the brand name of levothyroxine sodium tablets, USP – the generic version.

T3 – Cytomel (liothyronine sodium)

Generics must follow the precise formulation in regards to the active ingredient there may be a difference in the inactive ingredients, so take notes of your reaction when beginning any long term medication.

Synthetic vs. glandular – there isn’t much evidence supporting a difference, but I caution the use of any hormone supplementation due to the level of risk associated. Always discuss usage with your endocrinologist.

Hormones also take a long time to act, so you won’t be able to feel or detect any difference for weeks after beginning or changing dosages.

Diet:

There isn’t much that angers me, but this is a big one. There are several woo peddlers out there using their credentials (letters behind your name) to promote books/diets/services. You cannot “heal” your endocrine system with diet. You can only treat this with medicine.

While there is no “thyroid diet”. There are specific foods you want to avoid taking at the same time as your supplement:
  • Walnuts
  • Soybean flour
  • Cottonseed meal
  • Iron supplements or multivitamins containing iron
  • Calcium supplements
  • Antacids containing aluminum, magnesium, or calcium
  • sucralfate (Carafate)
  • cholestyramine (Prevalite) and colestipol (Colestid)

Many simply avoid taking food when taking your supplement. I recommend at least 60 mins before eating anything following taking thyroid medication.

Treatment:

Calories

If you have a thyroid disorder your struggle is pretty much identical to that of anyone else. There is no measurable impact to basal metabolism. There may be an impact to appetite due to a hormonal imbalance or shift, so it makes it critical to understand the difference between hunger and appetite.

Hunger is your body’s physiological need for food. The urge comes slowly over time and builds up. It is satiated with any food.

Appetite is your desire for food. These urges are more sudden and specific – driven hormonally. This results in these cravings of salty, sweet, crunchy, chocolate, etc.

There are several methods of managing this – if you have the urge to eat drink water and wait 30 mins. Establish a routine around eating and meal times.

Another important element is satiation. This is a very personal issue and something you need to experiment with your diet. Many find higher fiber foods more satiating. Spicing up foods is another common practice as the taste lingers in your mouth; people tend to feel the urge to eat diminish if taste is present.

Exercise

This is where I think many people sabotage themselves. When the majority of people make the decision to do something about their weight, they turn to a search engine – find “The Fastest Way to Lose Weight – Guaranteed!” and implement some drastic change. When you already have a problem regulating hormones this can be disastrous. You start out strong, but over time motivation fails and your body cannot keep up with the stress you’re putting it under. Pain increases as tissue repair begins to fall behind and eventually you miss a workout, then another, then depression. If coupled with a very low/low calorie diet this increases the chance of failure as your caloric deficit is too great.

The key to success is slow and gradual progress with a condition like this. Elite athletes with hypothyroidism still compete and are successful, but they plan ahead and gradually increase challenges. Note that thyroid disorders are increasingly common within endurance athletes as we tend to put our bodies through incredible endocrine stress. Warm up/cool down times should be increased. Hydration becomes all the more critical. Recovery times should be strictly adhered to.

Medical professional

Never attempt to diagnose or treat yourself and stay away from over the counter supplements. Without proper diagnosis you risk making things worse.

Finding a good physician may be the most challenging issue, although it is getting much better in the US. Talk to people who have succeeded. Research profiles on search engines. Specifically look for endocrinologists specializing in thyroid disorders. When you find a good one never let them go and let them know – spread the word! When you find a bad one let them know and fire them promptly if you can.

Dr. Jeffrey Brown revolutionized much of the treatment for elite level athletes and his methods are carrying over through the specialty. I cannot stress how much of a difference having a sound relationship with your primary physical and endocrinologist means to your life.

Bring data to every discussion. Document in MFP or a diary and share this with your doctor.

What Does Not Matter:

Pretty much everything else. It doesn’t matter much how you developed this or what variation of disorder you have – the treatment is all the same.

There are a multitude of primary causes for hypothyroidism, none of which matter in weight management. Regardless of how you came to a non-functioning thyroid gland there is nothing preventing you from maintaining a healthy weight.

What to focus on:

Prioritization


Prioritize what matters – Medical treatment > Caloric Intake > Exercise

The Pareto Principle

“80% of the effects come from 20% of the causes.”


Known as the 80/20 rule this remains a factor that continually presents throughout disciplines. What this means for you is to focus on the 20% of your life that matters and disregard the 80%. Now this is going to change over time and there will be competing priorities throughout your life. Keep this principle in mind when you feel out of control and thinking you need to control it all – you only need to be concerned with 20% of it.

168 Hours

When I first entered into the military I was thrown into one of the highest operational tempo fields and found myself continually struggling for time. My Chief saw this and sat me down explaining “Listen – there are 168 hours in the week. There’s always time to do what needs to be done.” If you’re struggling thinking I don’t have time – first review if it’s even worth the energy following the 80/20 rule, then budget it into your 168 hours/week.

Fatigue

All hormonal shifts result in fatigue so coping mechanisms against this are critical. Caffeine helps, but don't overuse. What helped me was to force myself to be 100% focused and excited about whatever was in front of me and to consider every opportunity as if it were the greatest opportunity in the history of the universe. Not going to say I was always successful at this, but it certainly helped. You have to remember that the hormonal imbalance will trend back to normal and focus on the future. Meditate. Pray. Do whatever it takes to get yourself through the low troughs.

Perspective & Attitude

I save this for last as I believe this to be the most important. When I was first diagnosed with cancer I spent a great deal of time researching survivors and found a common link – they went into this realizing that holding a positive attitude was going to be critical to success. I also noticed a disproportionate percentage of elite level athletes, academics, professionals in all areas. A majority reported similar epiphanies that could be summed up as “Life is incredibly short and we have a limited amount of time on this Earth to do good, so get to it.”

You can look at this from two perspectives - two stories:

1. “Crud. I have to take this stupid pill for the rest of my life”
2. “Incredible! All I have to do is take this little pill to live my life”

Both stories are true, but which would you rather be in.

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Replies

  • ElizabethKalmbachElizabethKalmbach Member Posts: 1,416 Member Member Posts: 1,416 Member
    And when the suggestion banner at the bottom of your meat chassis flash, "FREQUENTLY COMORBID WITH:" do not buy. SRSLY. None of the recommended ailments go well with water retention.
    edited October 2019
  • claireychn074claireychn074 Member, Premium Posts: 497 Member Member, Premium Posts: 497 Member
    Thank you for such an informative overview. I had an adrenal issue and feel similarly irritated about people peddling adrenal insufficiency cures: if people want to know what adrenal insufficiency feels like, try living normally after the removal of a sizeable dopamine-secreting pheochromocytoma. It’s not fun. And as I’m now being investigated for thyroid issues, I really appreciate the information provided. So thanks.
  • cheryldumaischeryldumais Member Posts: 1,932 Member Member Posts: 1,932 Member
    Sharon_C wrote: »
    I'm so glad to see a detailed post like this. I had my thyroid removed last December after YEARS of being hyper. My biggest fear was gaining weight because I'd worked so hard to lose it. I did a lot of research. I whole lot of research. I managed to wade through the fluff and scare tactics to find the real research and discovered that a well-medicated person without a thyroid is just the same as a person with a normal functioning thyroid.

    Since removing my thyroid I have lost weight just as easily as before. I still put the time in the gym that I used to. Basically my life has moved on with barely a ripple of change.

    Thank you for this post.

    Thank you for sharing!
  • ElizabethKalmbachElizabethKalmbach Member Posts: 1,416 Member Member Posts: 1,416 Member
    CSARdiver wrote: »
    I've been researching this for some time and see the objective evidence supporting the rise of thyroid disorders and several other disorders being due to obesity and not the reverse.

    I think root cause analysis is important for each instance of a particular condition, due to my aforementioned and utterly unwanted list of comorbid conditions.

    If the root cause is cancer, doctors tend to stay alert for other types of cancer. If the root cause is autoimmune, then it would be nice if one's doctor stayed alert for other autoimmune disorders with similar or *masked* symptoms to the original condition.

    I suspect this is why normally sane and reasonable people start attributing things they should not to their thyroid problem.

    They don't have any other explanation and that's the only problem they knew of - even though their doctor told them the problem was solved.

    It's easy to buy snake oil if you're desperate for an answer if people around you think you're non-compliant to normal advice and your doctor just writes you of as a hypochondriac.

    I can't decide if it would be more or less helpful for doctors to tell people what to be on the look out for, though I firmly believe it would be helpful for them to take the time to explain medications and dosing regimens properly instead of just handing out slips of paper and trotting people out the door in 15 minutes or less, leaving the rest to the pharmacist to sort out.
  • corinasue1143corinasue1143 Member Posts: 5,316 Member Member Posts: 5,316 Member
    Thanks so much for explaining this. As someone who has never had thyroid problems, I didn’t understand any of this, wasn’t familiar with the terms. My daughter has thyroid problems. I tried to research, but always got lost. By reading this, I can now understand a little, and even lend a sympathetic ear, really knowing what’s going on.
  • denjan333denjan333 Member, Premium Posts: 158 Member Member, Premium Posts: 158 Member
    Great post! Lots of helpful info.

    I will just give a little perspective from someone in Canada. I have hypothyroid and have been taking Synthroid for years and years. While circumstances will be different for those who lose function of their thyroid via cancer or some other disease, the USUAL case is that your family doctor will do a simple blood test. You don't get to request anything. They don't care about your paperwork or what you ask for. This has been my experience over many GPs in the last 15 years. This is the Canadian system. Unless you can afford to go to a private clinic or you're seeing a specialist, there's just not much you can request. I suppose you could request to see a specialist, but if it's just a low thyroid with no other extenuating circumstances, the likelihood of that happening is slim to none.

    I go for regular blood tests (have a standing order that lasts 2 years) and just make sure I take my medication every day, as prescribed. I have no issues with losing weight, at all.
  • Pearl4686Pearl4686 Member Posts: 834 Member Member Posts: 834 Member
    Thank you so much @CSARdiver. This makes me feel so much better. I have been worrying myself sick because my doc wants to reduce my meds. Apparently it is showing up as though I am overmedicated now. He's waiting 6 months for a new test but I admit I've had issues sleeping at night and my moods have been swinging wildly so I probably need it adjusted. Losing weight has really messed with all my medications. Your post made me realize I'm not going to gain all the weight back from a reduction.

    I went through exactly this! I lost 40lbs with MFP and started having hyper symptoms (heart palpitations and hair loss)
    I totally panicked when my blood test showed I'm over-medicated. I posted about it in another thread (being honest, I was a lot less educated back then) and was reassured there will be no dramatic changes. And that's how it was.
    Sadly, I'm now eating wrong, so no longer losing weight.
    An interesting angle here, which my doctor couldn't confirm not deny, is whether weight loss might directly reduce the need for meds i.e. improve one's thyroid function.
  • maureenkhildemaureenkhilde Member Posts: 850 Member Member Posts: 850 Member
    Great Post! I remember my endocrinologist explaining how my thyroid was basically being a slug and that I needed the synthroid/levothyroxine. And he went over each test he had run and what the results meant. And how often and which tests would be run ongoing.
    I received a great tip from someone in their office. I was asked do you get up early in the morning to go the bathroom? I said yes, the suggestion was take your levothyroxine then. Which is about 2 hours before I normally get up and start my day. So solved the issue of it causing issues with food. And have never had an issue with odd test results.

    But very detailed post, I enjoyed it.
  • CSARdiverCSARdiver Member Posts: 6,256 Member Member Posts: 6,256 Member
    Great Post! I remember my endocrinologist explaining how my thyroid was basically being a slug and that I needed the synthroid/levothyroxine. And he went over each test he had run and what the results meant. And how often and which tests would be run ongoing.
    I received a great tip from someone in their office. I was asked do you get up early in the morning to go the bathroom? I said yes, the suggestion was take your levothyroxine then. Which is about 2 hours before I normally get up and start my day. So solved the issue of it causing issues with food. And have never had an issue with odd test results.

    But very detailed post, I enjoyed it.

    I do the same thing - set my alarm for 5am, take the pill and drink 16 oz water. I now just get up and workout, but yeah - this set a barrier between meals as I don't eat anything until 10am.
  • tentcamptentcamp Member, Premium Posts: 1 Member Member, Premium Posts: 1 Member
    I do the same, set my alarm for 5am, but I usually am up to use the bathroom at that time anyway. Works fine for me!
  • cheryldumaischeryldumais Member Posts: 1,932 Member Member Posts: 1,932 Member
    Pearl4686 wrote: »
    Thank you so much @CSARdiver. This makes me feel so much better. I have been worrying myself sick because my doc wants to reduce my meds. Apparently it is showing up as though I am overmedicated now. He's waiting 6 months for a new test but I admit I've had issues sleeping at night and my moods have been swinging wildly so I probably need it adjusted. Losing weight has really messed with all my medications. Your post made me realize I'm not going to gain all the weight back from a reduction.

    I went through exactly this! I lost 40lbs with MFP and started having hyper symptoms (heart palpitations and hair loss)
    I totally panicked when my blood test showed I'm over-medicated. I posted about it in another thread (being honest, I was a lot less educated back then) and was reassured there will be no dramatic changes. And that's how it was.
    Sadly, I'm now eating wrong, so no longer losing weight.
    An interesting angle here, which my doctor couldn't confirm not deny, is whether weight loss might directly reduce the need for meds i.e. improve one's thyroid function.

    Yeah I wondered about some of this too. What I’m really curious about is how my new walking program might have affected it.
  • spiriteagle99spiriteagle99 Member Posts: 3,116 Member Member Posts: 3,116 Member
    AFAIK, losing weight made no difference with my medication. I lost 55 lbs and have kept it off for the past few years, but my medication didn't change at all between my high weight and my low weight. I get a blood test every year to check levels, though they only do TSH, not T3 and T4.
  • ElizabethKalmbachElizabethKalmbach Member Posts: 1,416 Member Member Posts: 1,416 Member
    AFAIK, losing weight made no difference with my medication. I lost 55 lbs and have kept it off for the past few years, but my medication didn't change at all between my high weight and my low weight. I get a blood test every year to check levels, though they only do TSH, not T3 and T4.

    I've gained and lost the same 30-40 lbs and my dose didn't change much, because a lot of that is retained fluid. My dose DOES change though, when I go through an intermittent period of thyroid function or interacting vitamin deficiency. That said, my thyroid has probably been good and dead for about a decade now, so my dose has been fairly stable for the last 10 years out of 20.

    Last time my dose was lowered it was because I started getting B12 by injection after being deficient for years. You apparently need B12 to use the synthroid or thyroid hormone efficiently. Once I had B12 available, I didn't need as much synthroid. (by like 12mcg per day).
  • Pamela_SuePamela_Sue Member Posts: 564 Member Member Posts: 564 Member
    @CSARdiver Thank you for the great post. A question for you. I am on the generic levothyroxine but heard from a pharmacist years ago that the name brand Synthroid is better. The reason being that, with the generic, you won't consistently receive the same generic and it can effect a person. Therefore the Synthroid provides consistency.

    Any thoughts on this? I have a long-standing struggle with low mental energy. Probably from my depression, but I am always looking for any micro-mini improvements I can make in my life.
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