A few steps helps keep those with hypothyroidism happy on the scale.

If you have been diagnosed with hypothyroidism, know that you may be frustrated with efforts to lose weight. This is an extremely common condition that has important health and weight implications. Hypothyroidism spares no age group, but is most prevalent in women over 60 year old.

Hypothyroidism is currently diagnosed in an estimated 27 million people in the United States. Millions more are undiagnosed, under-diagnosed or under-treated. Additionally, medical doctors are finding more often that subclinical hypothyroidism, i.e., low thyroid function without symptoms like fatigue or feeling cold, can affect people at any time in their lives simply due to poor nutrition.

Slowed Metabolism, Slow Burn of Calories

When the thyroid gland is not sufficiently active, it can lead to weight troubles. Thyroid hormones, T4 and T3, regulate the body’s metabolism—they provide every cell in the body with the energy needed to function. They are critical for burning calories. If levels of thyroid hormones are low, you burn fewer calories per day. An underactive thyroid makes every calorie count more, sometimes double. It makes losing weight a slower process or makes it twice as difficult.

Clinical signs and symptoms of an underactive thyroid are the result of a slowed metabolism—weight gain, weakness and fatigue, persistent constipation, cold hands and feet, dry and flaky skin, thinning hair, brittle nails, and a slow pulse (1;2).

Hypothyroidism Clinical Signs and Symptoms (1;2)

Weakness and fatigue

Hair that is dry, brittle or thinning

Slow pulse rate

Nails that tend to be dry, brittle or break easily

Persistent constipation

Cold hands and feet

Thick and swollen tongue

Rough, dry, or flaky skin

Keeping a Normal Thyroid Functioning At Its Best

A healthy diet supplying sufficient amounts of minerals such as iodine, selenium, iron and zinc can be key for supporting thyroid metabolism. Of these minerals, iodine and selenium are most important and often lacking in the Western diet, particularly now in health conscious people who are reducing salt intake since the best source of this mineral is iodized salt.

Suboptimal intake of iodine or selenium—or in some cases too much intake, which is rare—can lead to  subclinical or full-blown hypothyroidism. The thyroid gland converts iodine from the diet to thyroid hormones T1, T2, T3, and T4. The most potent is T3 (triiorodyronine), which is three times more potent than T4 (thyroxine). T3 is made up of tyrosine and three molecules of iodine. T4 contains an additional molecule of iodine. Selenium is needed in sufficient levels because it is required for enzymes to convert T4 to T3.

Good dietary sources of iodine include iodized salt and sea vegetables such as edible kelp (often eaten with miso soup or as a garnish) and nori (used for wrapping sushi). Good sources of selenium are animal products, seafood, dairy, and Brazil nuts. (Salts like sea salt, Kosher salt, gourmet salts, and most low-sodium salts have little to no iodine.)

Five Steps for Losing Weight with Hypothyroidism

Weight management approaches for patients with  hypothyroidism do not differ much from others without the condition. Nonetheless, here are a few tips to help achieve the greatest overall results.

Step 1: Make Sure You Are Properly Diagnosed and Treated By a Qualified Doctor

Getting a proper diagnosis and treatment from a doctor is essential to gain your health and figure back.

Diagnosis depends on results of a blood test that measures levels of thyroid hormones, free T3 and free T4, and thyroid-stimulating hormone (TSH). The pituitary gland should secrete more TSH when thyroid hormone level is low. When levels of thyroid hormone are low and levels of TSH are high, the tests indicate hypothyroidism. (The precise cutoff that determines hypothyroidism is hotly debated. The American Thyroid Association currently suggests that a TSH of 2.5 mIU/L or greater suggests hypothyroidism. Some practitioners use an even lower cutoff, while many mainstream practitioners tend to follow older guidelines and look for a level above 4.5 or 5.5 mIU/L.)

Doctors will typically prescribe levothyroxine (Synthroid®), synthetic T4, in amounts necessary to return levels to a normal range in the body. Many prefer to prescribe ArmourÒ thyroid, which is naturally derived, and contains both T4 and T3 thyroid hormones. A new synthetic T3/T4 combination is also on the market (Liotrix). The T3 hormone, called “liothyronine,” can also be taken, either with T4 or by itself. Sadly, T3 is often neglected by many mainstream practitioners. If no mention is made of your T3 status, it is important to ask about T3 specifically, since some people have impaired ability to convert T4 to the active T3. Lack of T3 can impair your weight-loss efforts.

Step 2: Avoid Hijacking Thyroid Hormones

When taking any of these thyroid hormones, it’s important to heed your doctor’s recommendations, as certain foods and nutrients can interfere with absorption.

For example, dietary intake of calcium or iron can inhibit thyroid hormone absorption. A general recommendation from doctors is to take thyroid hormone (usually immediately upon arising in the morning) four hours apart from calcium- or iron-containing foods.

It’s also important to avoid overconsumption of goitrogenic foods. Goitrogens are compounds that may interfere with thyroid function by blocking an enzyme, called thyroid peroxidase, from coupling iodine to tyrosine to produce thyroid hormones.

Common goitrogenic foods in the diet include non-fermented soy foods, legumes such as lima beans, and raw cruciferous vegetables such as broccoli, cauliflower and Brussels sprouts. Preparation methods, such as cooking or fermentation, reduce the amount of goitrogens in these foods. The addition of sea vegetables, like kelp, or including sufficient iodine in the diet can nearly always counteract goitrogens from crucifers and soy.

Step 3: Eat Balanced Meals with Quality Protein, Especially at Breakfast

Eating regular, balanced, calorie-controlled meals is key to losing weight with hypothyroidism. Each meal should emphasize healthy amounts (approximately 20 to 30 grams) of quality protein. Protein is the most satiating of the macronutrients—shown in studies to curb hunger for longer periods than carbohydrates and fats—and helps to preserve metabolism-boosting muscle.

The amount of protein recommended is 0.8 grams per kilograms spread throughout the day. Breakfast is the most important time to focus on protein because most people don’t get enough in the morning, the time when muscles need protein the most (with the exception of those few hours right after workouts).

Not all protein sources deliver the same results for muscle and satiety. Whey protein, for example, contains rich amounts of branched-chain amino acids (BCAAs), which are important for muscle, and can be highly satisfying compared to other protein sources.

Step 4: Eat Foods High in Fiber, Cut Refined Sugars and Carbohydrates

Refined carbohydrates are a source of “empty” calories that hinder weight loss efforts. Refined carbohydrates also lack dietary fiber that is important for helping provide bulk for solidifying and softening stools. Getting enough dietary fiber can help avoid hypothyroidism-induced constipation. Fiber is also satisfying, which helps reduce calories to support weight loss.

According to the National Fiber Council, the recommended intake daily is 25 to 30 grams of dietary fiber daily. Those unaccustomed to eating these amounts of dietary fiber should increase intake gradually to avoid gas and bloating.

Step 5: Exercise Regularly Throughout the Day . . . and Don’t Forget Resistance Training

Even a few minutes of exercise is enough to boost metabolism for burning more calories. So, taking a moment or two to run up a flight of stairs or do a few jumping jacks every few hours can be enough to boost metabolism and burn more calories.

Exercise contributes to weight loss by doing more than actively burning calories. Progressive resistance training combined with regular intake of quality protein will help build muscle, which in turn boosts basal metabolic rate. A higher basal metabolic rate burns more calories over time.  Muscle takes up less space than an equivalent weight of fat, so you look trim and fit, too!

A brief amount of exercise periodically throughout the day also helps keep your gut in working order. It stimulates movement of food through the gastrointestinal tract and helps you to avoid constipation.

Stay Consistent: Don’t Be Hampered by Hypothyroidism

It’s important for people with hypothyroidism to know that the condition doesn’t have to be the obstacle that keeps them from their health and weight loss goals. Having the right attitude about being treated correctly by a doctor and making the effort to lose weight can go a long way. As you take advantage of each of the steps given here, stay consistent, create goals for yourself, and make yourself accountable for those goals. You’re sure to enjoy fantastic results!

This article was written by William Davis, MD, a practicing cardiologist in the Milwaukee area. He is a graduate of St. Louis University School of Medicine and obtained his training in medicine and cardiology at the Ohio State University Hospitals and Case-Western Reserve MetroHealth Medical Centers.

Reference List

1. Kohlstadt I. Food and Nutrients in Disease Management. Boca Raton, FL: CRC Press, 2009.

2.Shils ME, Shike M, Ross AC, Caballero B, Cousins RJ. Modern Nutrition in Health and Disease. Baltimore, MD: Lippincott Williams & Wilkins, 2009.