Published September 25 2017
For many people with hyperthyroidism and Graves’ Disease, extreme weight loss is an issue. In fact, when I dealt with Graves’ Disease I lost over 40 pounds, and I had a difficult time gaining weight. It’s a similar situation for many of my hyperthyroid patients, and the reason for this is due to the elevated thyroid hormone levels. However, some people with hyperthyroidism and Graves’ Disease have difficulty losing weight. In other words, weight gain is an issue for some hyperthyroid patients. And in this article I’m going to discuss some of the most common reasons why this is the case.
So let’s go ahead and discuss ten reasons why some people with hyperthyroidism and Graves’ Disease might experience weight gain and have difficulty losing weight:
1. Taking antithyroid medication. The most common reason why some people with hyperthyroid conditions gain weight is because they are taking antithyroid medication [1]. This includes Methimazole (i.e. Tapazole), Carbimazole, and PTU. And the reason for this is because taking antithyroid medication will decrease thyroid hormone levels, which in turn will slow down the metabolism, and thus contribute to gaining weight.
2. Their hyperthyroid condition is subclinical. Subclinical hyperthyroidism [2] is when someone has a depressed TSH, and the thyroid hormone levels are normal. Some people also have subclinical Graves’ Disease, which is when they have a depressed TSH, elevated TSH receptor antibodies, and normal thyroid hormone levels. This condition itself won’t cause someone to gain weight, as there are usually other factors involved.
3. They also have the antibodies for Hashimoto’s Thyroiditis. It’s not uncommon for people with Graves’ Disease to also have the antibodies for Hashimoto’s Thyroiditis. These include the thyroglobulin antibodies and the thyroid peroxidase antibodies. The presence of these antibodies means that the immune system is damaging the thyroid gland, and the elevated thyroid hormones associated with hyperthyroidism can eventually become depressed due to the damage. This is why doing a thyroid panel on a regular basis is important. At the very least this panel should consist of the TSH, free T3, and free T4. While it usually takes time for significant damage to the thyroid gland to occur which results in low or depressed thyroid hormone levels, everyone is different, and so just because your thyroid hormone levels were elevated a few months ago doesn’t mean that they are still elevated now (although they might be).
4. Estrogen dominance. Imbalances of the sex hormones can cause someone with hyperthyroidism to gain weight. Estrogen dominance is the main culprit, and while hormone replacement therapy and oral contraceptives can be factors in some people, one of the biggest factors is exposure to xenohormones. While you probably won’t be able to completely eliminate your exposure to these chemicals, most people can do things to reduce their exposure, which I’ll discuss later in this article.
How can you tell if you have estrogen dominance? Testing the sex hormones is probably the best way, although keep in mind that having normal blood levels of estrogen doesn’t rule out estrogen dominance. Although sometimes I’ll see high levels of estradiol (the most dominant form of estrogen) in the blood, most of the time these levels are normal. On the other hand, it’s very common to see low serum progesterone levels. Getting back to estrogen, salivary testing measures the free form of this hormone, and another option is doing a urinary test for estrogen. The advantage of urinary testing is that it looks at the estrogen metabolites, which include 2-hydroxyestrone (2-OH-E1), 4-hydroxyestrone (4-OH-E1), and 16α-hydroxyestrone (16α-OH-E1). These metabolites have different biological activity, as the 2-OH metabolite has weak estrogenic activity, and thus is labeled as being the “good” estrogen.
5. Poor diet. Most people with hyperthyroid conditions have a voracious appetite, and thus it’s quite common for them to consume a lot more calories than usual. However, this frequently doesn’t result in weight gain, and in fact, many people struggle to gain weight, even though they are eating a high amount of calories. However, certain foods are more likely to cause weight gain than others. For example, eating a lot of refined carbohydrates and sugars can be a big factor in gaining weight. And one of the main reasons for this is because such a diet is likely to increase insulin levels, and over time it can lead to a condition such as insulin resistance, which as discussed below, is commonly associated with weight gain.
6. Chronic stress and high cortisol levels. There is evidence that chronic stress [3] and high cortisol [4] levels can play a role in obesity (1) [5] (2) [6]. And so it makes sense that if someone with hyperthyroidism or Graves’ Disease has elevated cortisol levels then this might be a factor that can make it difficult to lose weight. However, I will say that chronic stress is a factor in most of my patients with Graves’ Disease, and so this alone usually won’t cause weight gain. Keep in mind that not everyone who deals with chronic stress has elevated cortisol levels, as when I was diagnosed with Graves’ Disease my cortisol levels were depressed. I’ve also worked with patients who had elevated cortisol levels but still lost a lot of weight. And so high cortisol levels alone won’t always make it challenging to lose weight, although it can be a factor.
7. Inflammation. Although inflammation is a factor with every autoimmune condition, everyone has different amounts of inflammation. Some of the different markers of inflammation [7] include C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and fibrinogen. However, there are other inflammatory markers that can be measured such as calprotectin, lactoferrin, lysozyme, and secretory IgA [8]. It’s important to understand that many people with Graves’ Disease will test negative for these, although this doesn’t rule out inflammation. On the other hand, if one or more of these markers come out positive then this is a sign of moderate to severe inflammation, and sometimes this can be a factor in weight gain.
And while the thyroid antibodies [9] don’t always correlate with the severity of the inflammation, I will say that in most cases, the higher the thyroid antibodies, the more inflammation someone has. This is especially true with thyroid stimulating immunoglobulins, which are associated with Graves’ Disease. For example, in my experience, someone with very high TSI levels is more likely to have one or more positive inflammatory markers. I will also add that those with higher TSI levels are more likely to have thyroid eye disease [10], and in the literature there is a correlation between Graves ophthalmopathy and obesity (3) [11]. Once again, this isn’t to suggest that most people with thyroid eye disease will have problems with weight gain, but weight gain issues are more common in those with this condition.
8. Insulin resistance [12]. This relates to diet and inflammation, as what happens is that the insulin levels remain high, and the cells become resistant to the effects of insulin. There is an excellent book called “The Obesity Code”, which was written by Dr. Jason Fung, who is a nephrologist. Dr. Fung sees a lot of diabetics in his practice, and he has a lot of experience with insulin. And in his book he talks about the role of excessive insulin in weight gain, and thus, how losing weight is dependent on reducing high insulin levels. But the research also shows that proinflammatory cytokines [13] can be a factor in insulin resistance (4) [14] (5) [15], and so it also is important to do things to decrease inflammation.
How can you find out if insulin resistance is a factor? You can obtain a few different markers in the blood that can give you a pretty good idea, and in many cases will confirm or rule out insulin resistance. While looking at the fasting glucose levels can provide some value, I also would consider measuring the fasting insulin levels. Hemoglobin A1C is another marker to look at. Please keep in mind that an iron deficiency can lead to falsely elevated hemoglobin A1C levels, and as a result, correcting an iron deficiency can lower hemoglobin A1C (6) [16]. So when measuring hemoglobin A1C it also is a good idea to order a complete iron panel as well.
9. Insufficient sleep. Many people with hyperthyroidism have problems falling and/or staying asleep. And in the literature there is a correlation between short duration of sleep, poor sleep quality, and obesity (7) [17] (8) [18]. One reason why sleep can lead to obesity is because sleep is an important modulator of neuroendocrine function and glucose metabolism, and as a result, sleep loss has been shown to cause decreased glucose tolerance, decreased insulin sensitivity, increased evening levels of cortisol, and decreased levels of leptin [19](8) [18]. In addition, sleep deprivation can also result in inflammation (9) [20] (10) [21], which as I already mentioned is a factor in obesity.
10. Environmental toxins. I’ve actually written an article on obesogens [22] that discusses the effects of environmental toxins on obesity. Obesogens are endocrine disrupting chemicals, and they interfere with the body’s adipose (fat) tissue biology, and they also interact with the hormone receptors, which in turn disrupts the endocrine signaling pathways, and thus can be a factor in gaining weight (11) [23]. As I mentioned earlier, xenohormones are a big factor when it comes to estrogen dominance. Bisphenol A [24] (BPA) and pthalates can contribute to weight gain, and other obesogens including persistent organic pollutants (POPs), pesticides, polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs) have been shown to accumulate in adipose tissue after exposure (11) [23].
As I briefly mentioned earlier when talking about xenohormones, you won’t be able to completely avoid these environmental toxins. And so the next best thing is to minimize your exposure to them, and to also do things to eliminate them from your body, which I’ll talk about shortly.
How To Overcome Weight Gain
When someone with hyperthyroidism and Graves’ Disease are having problems losing weight, the obvious solution is to find out why the person is gaining weight in the first place. Sometimes this is an easy solution, as if someone is taking antithyroid medication then it might just be a matter of stopping the medication, although it’s always wise to consult with your doctor before doing this. After all, the risks of untreated hyperthyroidism is arguably greater than gaining weight. But in some cases the person is taking too high of dosage of antithyroid medication, while in other cases they might be taking a smaller dosage (i.e. 5 to 10 mg per day), but sometimes this is still sufficient to prevent someone from losing weight.
On the other hand, if antithyroid medication isn’t the culprit, then you will need to look elsewhere, and you might want to consider doing one or more of the following:
1. Eat a clean diet. Although diet might not be the primary reason why some people with hyperthyroid conditions gain weight, it can be a factor in some cases. Ideally you want to eat a diet consisting mostly of whole foods, and you especially want to minimize the consumption of refined carbohydrates and sugars. If you are eating a healthy diet then I wouldn’t worry about eating too many calories, and I definitely wouldn’t cut out the fats. Some people will load up on protein and reduce their fat intake, but eating healthy fats such as avocados and coconut oil [25] won’t cause you to gain a lot of weight. In fact, many people follow a ketogenic diet to help lose weight. Regardless of whether a patient of mine is trying to gain or lose weight, I encourage them to eat plenty of healthy fats, and to get most of their carbohydrates from vegetables.
2. Improve your stress handling skills. As I mentioned earlier, chronic stress and high cortisol can be a factor in weight gain. While you won’t be able to eliminate all of the stressors in your life, most people can dedicate more time each day to stress management.
3. Do things to reduce inflammation. There of course is some overlap between diet and inflammation, as eating refined foods and sugars, fast food, and making other poor food choices can cause inflammation. But while eating an anti-inflammatory diet can greatly help, many times doing this isn’t sufficient. And the reason for this is because there are other factors which can cause inflammation, including stress, infection, and environmental toxins.
Having healthy vitamin D levels is important in order to reduce inflammation, and if you haven’t been recently tested for vitamin D then I would highly recommend doing so. If you are deficient then regular sun exposure and supplementation is recommended.
Speaking of supplementation, taking certain nutritional supplements can help to reduce inflammation. Two of the most common supplements which can help accomplish this are fish oils [26] and curcumin [27]. But of course taking supplements will have a minimal impact if you aren’t eating a healthy diet, doing things to improve your stress handling skills, and aren’t getting sufficient sleep.
4. Decrease insulin resistance/increase insulin sensitivity. Some of this relates to diet, as if someone is eating a lot of refined carbohydrates and sugars then without question this can be a factor in insulin resistance. Certain nutrients can help to increase insulin sensitivity, including chromium, magnesium [28], alpha lipoic acid, vanadium, and bitter melon. Berberine is also something to consider for those who have hyperglycemia and insulin resistance, and in some people it might be a good option to take berberine instead of Metformin (12) [29], which is commonly recommended for those with type 2 diabetes. Regular exercise can also help to increase insulin sensitivity (13) [30] (14) [31]. Earlier I also mentioned that inflammation is a factor, and so you need to address this problem as well.
5. Balance the sex hormones. Imbalances of the sex hormones can cause someone with hyperthyroidism to gain weight. This is especially true when someone has estrogen dominance. I’ve written an article which discusses seven things you can do to improve estrogen metabolism [32], and so I’d make sure to check this out when you get the chance.
6. Make sure you get enough sleep each night. Everyone knows the importance of getting sufficient sleep, but many don’t consider this to be a potential cause of weight gain. This isn’t to suggest that everyone who doesn’t get adequate sleep will have problems losing weight, but if this is the case with you then you want to do everything you can do to get sufficient sleep each night. Many times in order to get better quality sleep you need to first focus on improving the health of your adrenals and address blood sugar imbalances.
7. Minimize your exposure to obesogens. Since certain chemicals can cause weight gain, you of course want to do everything you can to minimize your exposure to them. For example, if you regularly drink water out of plastic bottles, then you should try to avoid this, as the xenoestrogens can be a factor. Similarly, if you are using body creams and lotions with some of the chemicals I listed earlier then it’s best to switch to a natural alternative.
8. Support the detoxification pathways. While minimizing your exposure to environmental toxins is important, you also want to do things to eliminate these chemicals from your body. Eating a healthy diet with plenty of vegetables is essential, especially the cruciferous vegetables (i.e. broccoli, kale, cabbage, cauliflower, etc.). Taking supplements such as N-acetylcysteine [33] (NAC) or a liposomal/acetylated form of glutathione can also help to support detoxification. Another thing to consider is infrared sauna therapy, which will help you to excrete toxins through sweat.
In summary, while most people with hyperthyroidism and Graves’ Disease struggle to gain weight, some people with hyperthyroid conditions have difficulties losing weight. Some of the more common reasons for this include taking antithyroid medication, having estrogen dominance, inflammation, insulin resistance, insufficient sleep, and toxic overload. So for those people with hyperthyroidism who are struggling to lose weight, addressing one or more of these factors is essential.