How To Lose Weight With Hypothyroidism

​Sometimes we can be doing everything we know should lead to weight loss, including watching our diet and exercising, but still the weight will not come off – and can even continue to pile on. Many people discover that in this case there is an underlying issue preventing them from reaching their weight loss goals, and in a lot of these instances hypothyroidism can be the culprit. The good news is that if you have hypothyroidism it does not mean that it will be impossible for you to lose weight, it just means that you will have to go about it differently than someone with normal thyroid function.

​Common Mistakes When Trying to Lose Weight with Hypothyroidism

So you’ve been trying to lose weight and restricting your calories, but every time you just end up more fatigued than normal. So far you have been able to lose 5-10 pounds by dieting this way, this but the minute you begin eating normally again your weight goes RIGHT back to what it was before dieting.

Does any of this sound familiar to you? If you have hypothyroidism, it probably does.

This is because calorie restricted diets are actually harmful to patients with hypothyroidism, and can make your thyroid function even worse. ​When you limit the calories you consume you are telling your body that you are lacking the calories that you need to survive, so it tries to protect itself by lowering your metabolism. The way that it does this is by reducing the active amount of Thyroid hormone, or reducing Free T3 levels, as well as by increasing your Reverse T3 levels. Unfortunately, the majority of doctors do not even look into either of these, so many patients are not aware of their hypothyroidism issues.

Calorie restricted diets are harmful to patients with hypothyroidism

Balancing your Hormones for Weight Loss

Losing weight isn’t just about burning more calories than you consume. If it were that easy for everyone to lose weight then the rate of obesity would not look like it does in the chart below.

Prevalence of Obesity

There is a reason that there’s about a 1% chance that going on a calorie-restricted diet will lead to long-term weight loss. Calories do play a role, but it is what your body does with those calories that is far more important, and your hormones are what decide how your body is going to use them. Hypothyroidism can effect how your body uses those calories. Therefore the focus of your weight loss should not begin with cutting calories, but instead with balancing your hormones.


Hypothyroidism is incredibly common in the U.S. among adults. Overall, hypothyroidism affect approximately 1 in 20 adults.

prevalence of hypothyrodism

​Insulin resistance (AKA Diabetes) is also common with it occurring in almost 1 out of every 10 people.

Prevalence of diabetes and insulin resistance in the USA

​Not only are both of these common, the majority of hypothyroidism patients ALSO suffer from insulin resistance which leads to inflammation, an inability to lose weight and worsening hypothyroidism symptoms. Along with insulin resistance, there are many other issues that can accompany hypothyroidism and complicate matters including Thyroid resistance, Leptin Resistance, Estrogen Dominance, Low Testosterone and High Cortisol/Adrenal Fatigue.


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Optimal Thyroid Function

Before looking into your other hormones, you should first start with your thyroid. ​​Once your thyroid function has been optimized then you move on to testing for other hormonal imbalances.

If you thyroid looks like the results below, then your other hormone systems do not factor in. In this case, this is what is considered “normal” for thyroid results, however this patient was experiencing all the symptoms of hypothyroidism. Treatment with the correct medication and dosage resolved her symptoms, but many patients with results like this are simply left untreated, are under-dosed or given the incorrect medications.

Low Free t3 and low Free t4

1. ​Insulin Resistance with Hypothyroidism –

Is Insulin Resistance Sabotaging your Weight Loss Efforts?

Hypothyroidism is common, but so is insulin resistance, which many people suffer from and don’t even know it. According to statistics, as an adult in the U.S. you have about a 50% chance of having pre-diabetes or diabetes and insulin resistance is what actually leads to diabetes and high blood sugar.

Insulin resistance happens before you get high levels of blood sugar, but to understand why you must reverse insulin resistance in order to lose weight, you need to look at the physiology.

In the presence of insulin your body stores all of the calories that you eat as fat, and also when your insulin levels are high your body is not able to use fat cells for fuel. This means you are primarily using glucose as an energy source, and your glucose levels drop you will feel sluggish, have to rely sugar for energy and have strong food cravings every 2 hours.

So in order to burn fat, and in turn lose weight, you MUST first reduce your insulin levels.

This is depicted in the graph below:

Burning fat in the presence of insulin

What is Insulin Resistance?

Insulin is a hormone that increases when you eat a large amount of sugar. When everything is working correctly, this hormone takes sugar and puts it inside your cells to protect your body from having high levels of sugar in the blood. When your insulin levels stay chronically elevated, from things like having a lot of sugar in your diet, your body becomes resistant to insulin. These high levels of Insulin also cause you to store your calories as fat in your belly. This means that if you have high levels of insulin, you will still gain weight even if you are eating less calories.

Here are some symptoms typically seen in patients that have insulin resistance:

  • Inability to lose weight
  • Cravings for sugary foods
  • Belly fat (or visceral abdominal fat)
  • Dizziness and lightheadedness when fasting
  • Irritability when going long periods of time without food

How do you know for sure if you have Insulin Resistance?

The first step in identifying and diagnosing insulin resistance is by looking at Insulin levels in the blood. You will want to check fasting insulin levels (which should be less than 5), HgbA1c (which should be less than 5.3), fasting glucose levels (which should be less than 85).

In the example below the patient has pre-diabetes, which you can see with her fasting insulin levels that are greater than 5, and elevated HgbA1c. If your fasting insulin level is greater than 5, it will be impossible for you to lose weight.

Elevated insulin with hypothyroidism

Early signs of insulin resistance

​How to Reverse Insulin Resistance and Heal your Thyroid

Insulin resistance is treatable, despite what conventional medicine would have you think. The problem with the common treatment targeted at blood sugar is that it only resolves a symptom of insulin resistance. As insulin resistance increases, your blood sugar rises, and when it gets too high is when you are diagnosed with Diabetes – which is really just advanced insulin resistance.

Some medications can be helpful in treating and even reversing insulin resistance, but the majority treatment should focus on the following things:​

– Diet to reduce Insulin levels

Diet i​s an important factor for reversing insulin resistance, but it is usually not enough on its own – especially for advanced cases. What you eat can definitely lead to increased insulin levels, and then cause insulin resistance, however, once your levels are high enough they can start a vicious cycle and cause insulin resistance on their own. This is why changing your diet is a good and necessary first step, but not enough to reverse insulin resistance on its own.

You should strive to eat a nutrient-dense, whole-food diet that is low in refined carbohydrates and sugar.

insulin diet weight loss

High intensity interval training exercise (HIIT)

Exercise is important, but what most people don’t realize is that the type of exercise matters a lot – especially if you want to lose weight and/or reverse insulin resistance. High Intensity Interval Training (HIIT) gives you more bang for your buck in a shorter amount of time than other types of exercise, and is very helpful for sensitizing your body to insulin.

​HIIT consists of small bursts of activity with maximum effort for about 30 seconds, followed by 60-90 seconds of moderate activity. You should repeat this process 5-8 times in a single session, at least one time per week. This is more beneficial than doing cardio on something like an elliptical for 30 min for much less time.

Warning for hypothyroidism patients:

Do not start HIIT unless your thyroid and adrenals have been optimized and can handle the stress. Exercise of any kind puts stress and strain on the body. The benefits of exercise come from the healing process, release of endorphins and cellular changes associated with it. Exercise is important, but it’s better to take it easy at first or you can risk worsening your thyroid and adrenal function. ​If you are fatigued for several days after exercising, then that means you should to look at your thyroid and/or adrenal function. It is normal to feel tired or sore after exercise, but for no longer than 3 days.

Intermittent fasting

Fasting can be one of the most effective treatments, because every hour you go without eating carbs or protein, your fasting insulin levels continue to drop. Once it gets below 5, your body will then be able to unlock fat stores and burn fat for energy. ​If you decide to try a fasting protocol, check your fasting insulin level at the end to ensure that your level is less than 5.

​Here’s a slightly oversimplified explanation of how it works:

The longer you go without eating, the lower your insulin levels will become. Once you use up the most of the stored glucose in your liver, your body MUST start to use triglycerides found in your fat cells for energy. In this way, as your insulin levels fall, your fat cells become “unlocked,” and you are now able to burn fat for fuel, while also sensitizing your body to insulin in the process.

Do NOT attempt fasting if you are on insulin, because hypoglycemia could cause it could be harmful. You also should not begin intermittent fasting until your adrenals and thyroid function have been optimized.

If you begin fasting and experience any of the following, you may need to stop and optimize your thyroid and adrenals first:

  • Dizziness/lighteadedness
  • Tremors or “shakes”
  • Headache
  • Intense thirst
  • Extreme cravings
  • Increased urination

Here is how you can get started with a gentle intermittent fasting program:

Start with fasting for 12-14 hours.

  • Eat an early dinner at around 7pm.
  • The next day have a late breakfast/early lunch at 11:00am.

Repeat this twice per week. ​

​2. Thyroid Resistance and Leptin Resistance

Years of recurrent yo-yo dieting, combined with very low calorie diets or ones like the HCG diet can lead to chronic damage of the thyroid. While these diets do work to help you lose weight, it is usually only temporary. When you deprive your body of the calories it needs, it lowers your metabolism, decreases your thyroid function and increases your appetite to try to make up for it. This is what causes you to not only gain back any weight that you have lost, but you also lose muscle mass in the process.

When you repeat this process several times throughout your life, you can cause Thyroid Resistance, combined with Leptin Resistance.

Here is an example of what someone who has Thyroid and Lepin Resistance’s labs look like:

Thyroid Resistance labs

What can be frustrating about this is that your labs may appear to be completely “normal,” or in rage, like in the example above. However, it is not that they are normal, it is just that many doctors are not looking for the correct things.

When you have thyroid resistance, your body takes Free T4 (thyroxine) and converts it to inactive Reverse T3, while at the same time increasing leptin. This majorly slows down your metabolism and tells your body that you are always starving, when actually you are gaining weight and always hungry.

​The patient in the example above had these symptoms, and also had previously done 3 rounds of using the HCG Diet. With each attempt at this diet she was able to lose weight, but each time she lost less. The last time she did the diet she did not lose any weight. Before starting treatment, her Reverse T3 levels were very high, and her Leptin was 19 when anything above 12 is considered Leptin Resistance.

This study below shows the effectiveness of GLP-1 Agonists in reversing Leptin resistance, and also helping with weight loss (in non-diabetic women)

exentide for weight loss

If you think you have Thyroid Resistance or Leptin Resistance, here’s what you need to do:

  • Have your serum Leptin levels tested. Anything below 12 is considered normal, and anything above 12 is considered Leptin resistance. Also have your Free T3/Reverse T3 ratio checked so that you can see if you have too much thyroid-blocking hormone in relation to free and active Free T3. The ratio should be greater than 0.2, with anything less being considered thyroid resistance.
  • The best treatment for Thyroid Resistance is NDT and/or Liothyronine, or sustained release T3. While you are on T3 you should monitor your Reverse T3 levels regularly so that you know when you “wash” out the reverse T3 levels. Once those levels have reaches less than 5, you can start to take less Free T3. Approximately 2/3 of people respond to NDT, with the other 1/3 needing Pure T3.

3. Estrogen Dominance and Hypothyroidism

When you have too much estrogen in relation to your progesterone levels, it is called estrogen dominance. ​Estrogen dominance is something else that is very common for many women, but especially in women who also have Hypothyroidism.

There are in 3 different ways that you can have estrogen dominance:

1. Having too much estrogen and “normal” progesterone levels

2. Having too little progesterone and “normal” estrogen levels

3. Being exposed to too many xenoestrogens from your environment while having “normal” estrogen and progesterone levels

Along with many other symptoms, estrogen dominance causes you to gain weight in the hips, buttocks and thighs. Too little estrogen can also cause weight gain, like with menopause, so you should not just to looking for estrogen dominance unless you have a history of issues like PMS, PMDD, Fibrocystic breast disease, uterine fibroid and/or endometriosis.

estrogen dominance weight gain

The women in the example above has elevated levels of Estradiol, Estriol and Estrone in her blood, and also is not metabolizing and eliminating Estrogens very well through her liver – which has led to a build up of excess estrogen and metabolites. Her symptoms include weight gain and and inability to lose weight – especially in the buttocks and thighs. ​

The best approach to treatment is to optimize her liver function with herbs to help eliminate estrogen down the protective 2 hydroxy pathway, and then improve her ability to methylate with activate B vitamins. This leads to weight loss and the reduction and elimination or other Estrogen Dominance symptoms.

​If think Estrogen Dominance is playing a role in your inability to lose weight you should do the following:

  • Have your urinary Estrone, Estradiol and Estriol, as well as metabolites (16-hydroxy Estrone, 4-hydroxy Estrone and 2-hydroxy Estrone) tested on day 19-22 (mid-luteal phase) of your menstrual cycle.
  • If your labs indicate you do have Estrogen Dominance, you will need to improve your liver function, increase the amount cruciferous vegetables in your diet and consider supplementing with DIM or Indole-3-Carbinol to help metabolize excess estrogen through the liver. You can also consider using a FAR infra red sauna, and depending on your progesterone levels you could also incorporate a Bio-identical Progesterone cream to reduce symptoms

4. Low Testosterone, Insulin Resistance AND Hypothyroidism​

Many people thing that testosterone is only important for ​men, but it is also a very important hormone for Women as well. Testosterone helps to burn fat, build lean muscle and improves your overall mood. When women have low testosterone levels, they may feel flabby and have trouble losing weight and gaining muscle, as well as experience irritability, anxiety and/or depression. Another common symptom of low progesterone for both men and women is low libido, or a decreased sex drive.

The example below is of a patient who was complaining of low testosterone symptoms:

low testosterone weight loss

Insulin resistance testosterone weight loss

As you can see, her testosterone levels are in rage, but on the lower end, or what we call Low “normal.” ​If you look at the rest of her results, you can also see that she is suffering from insulin resistance. It is common for low testosterone and insulin resistance to come together, and it is important that you treat both issues if you want to see results in regards to weight loss.

In this case, using bioidentical low dose testosterone will allow the patient to lose weight, build muscle and improve her mood, while making dietary changes can reverse her insulin resistance.

If you think that you may have low testosterone and/or insulin resistance this is what you should do:

  • Have your Free and Total Testosterone levels checked. Your individual situation, including symptoms, will help determine what the optimal level should be for you. In general most women should be in the mid-range, unless you have a history of autoimmune disease or Hashimoto’s – in this case DHEA and Testosterone can help reduce autoimmunity. Also check for insulin resistance.
  • If your Testosterone levels are low, you can start with a low dose of a bio-identical testosterone cream, and then check your testosterone levels after 4-8 weeks. If you discover you also have insulin resistance and treat aggressively, it may cause a natural increase in Testosterone levels.

5. Adrenal Fatigue, Elevated Cortisol and Hypothyroidism

Another extremely common hormonal imbalance in patients with hypothyroidism is adrenal fatigue. This is partly due to the fact that when your thyroid hormone is low your body turns to cortisol to create energy, which leas to “adrenal fatigue” over time.

adrenal fatigue weight loss

Cortisol is the hormone that our bodies create in response to stress. It is supposed to reduce inflammation in the body and help it to cope with the stressor. It also increases insulin’s effectiveness in the body, which is good in the short-term, but not in the long-term as it leads to weight gain – especially in the belly. Adrenal fatigue begins with having elevated levels of cortisol for extended periods of time.

​Symptoms of elevated cortisol and adrenal fatigue include:

  • Feeling “wired but tired”
  • Extreme fatigue
  • Weight gain especially in the belly
  • Weight loss resistance
  • Food cravings for sugar and salt
  • Anxious or jittery feeling

The patient in the example below was dealing with stress from her job, only getting 5 hours of sleep per night, and was unable to rest or relax due to a highly stressful event that happened a year earlier in her life. As a result, she was consistently gaining weight and having other symptoms of high cortisol and adrenal fatigue along with hypothyroidism.

cortisol weight gain

If you think that you may have elevated cortisol levels and/or adrenal fatigue contributing to your inability to lose weight here is what you should do:

  • Check your Cortisol x4 throughout the day with a saliva or dried urine test. Serum/blood testing of cortisol levels are not reliable.
  • If your Cortisol levels are elevated, you can try a combination of the following: remove caffeine and stimulants from your diet, add higher amounts of salt to your diet, eat smaller portions more frequently, reduce stress, and supplement with adaptogens or adrenal glandulars.

Testing for Hormonal Imbalances​

Below is a table that lists the different imbalances, diagnostic tests and results that you should look into of you feel you have an issue with your hormone levels, or think you may have hypothyroidism. Keep in mind that there is a big difference between having “normal” and optimal levels. If you feel like crap don’t let anyone dismiss you because your labs are “normal.” It is probably not that your labs are normal, it is more likely that the correct tests are not being ordered, and/or that they are not being interpreted correctly.

Test Panels Optimal Levels for Health
Thyroid Deficiency Blood: · TSH, Free T3, Free T4, Reverse T3, Thryoglobulin Antibodies, Thyroperoxidase Antibodies, Sex Hormone Binding Globulin (SHBG), Ferritin, TIBC, Serum Iron

TSH: < 2

FreeT3: 1/3 of reference range

Free T4: 1/3 of reference range

Reverse T3: < 15

Thyroglobulin: <15

Thyroperoxidase: < 15 SHBG: · Male: 20-30 · Female: 70-80

Ferritin: 70-80

Serum Iron: Mid range

TIBC: 35-38%

Estrogen Dominance Urine: · Estrone, Estradiol, Estriol,16-hydroxy Estrone, 4-hydroxy Estrone and 2-hydroxy Estrone Optimal levels are highly variable, and must be compared to Progesterone symptoms. Generally 2-OH Estrone should be preferred over other pathways.
Progesterone Deficiency

Blood: · Progesterone

Urine: · Pregnanediol

Check on day 19-22 of Menstrual cycle if menstruating. Progesterone levels should be higher than Estrogen levels during days 19-22 (see image below).
Insulin Resistance Blood: Insulin (Fasting and 2 hours after meals), Hemoglobin A1c (Hgb A1c), Fasting blood sugar (FBS), Uric Acid, Fasting Triglycerides, Fasting HDL

Insulin: · Fasting: < 5 · 2 hours after meal: < 30

Hgb A1c: < 5.3

FBS: < 85

Uric Acid: < 5 Fasting trig: < 100 Fasting

HDL: > 60

Leptin Resistance Blood: · Leptin levels · Thyroid studies (above) · Insulin tests (above) Leptin: <12
Cortisol and Adrenal Fatigue

Urine: · Cortisol and Cortisone x4

Salivary: · Cortisol x4

Blood: · AM Cortisol (Not very accurate)

Range is relative and dependent upon the person. If cortisol levels are high = Early stage adrenal fatigue. If Cortisol levels are low = Late stage adrenal fatigue.

weight loss thyroid

Remember that we all are different, so even if you have tests results that look “similar” to some of these examples, it doesn’t mean you have the hormonal imbalance, especially if you don’t have the corresponding symptoms.

Be sure to see a doctor and get a proper evaluation if you think your hormones are out of balance, or you may have hypothyroidism. You do not have to go through your life feeling like you’re crazy because all of your labs come back “normal”. Many people feel vindicated when they have their labs evaluated by someone who is looking for the right things, and it turns out there is an abnormality.

Schedule an appointment today if you think you are having hypothyroidism symptoms.

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