How to Lose Weight With Thyroid Disease

headshot of Dr. Linda Khoshaba on a white background

Dr. Khoshaba

February 6, 2023

Do you have a thyroid condition and struggle with unintentional weight gain or an inability to lose weight? As we know, hypothyroidism can have many symptoms, including but not limited to cold intolerance, slower metabolic rate, weight gain, dry skin, edema, hair loss, fatigue, hyperlipidemia, brittle nails, and irregular menstrual cycles.

While addressing and managing your thyroid disease based on your blood work, it is not unlikely to still exhibit symptoms associated with hypothyroidism despite normal bloodwork. So, are you wondering how to lose weight with thyroid disease?

Why can losing weight with thyroid disease be a struggle?:

For starters, your thyroid is the master gland when it comes to energy metabolism. Hypothyroidism, especially when uncontrolled, very often leads to a sluggish metabolism. That’s why individuals will often feel cold and slothful and can sometimes present with elevated cholesterol levels.

First and foremost, you want to make sure your thyroid levels are optimal! What does optimal look like? Well, we look at your thyroid-stimulating hormone (TSH), Free T4 hormone, and Free T3 hormones. The ranges for some of these are fairly wide, so sometimes your thyroid levels may appear “normal” but are not optimized.

Thyroid Stimulating Hormone (TSH)

An image showing the thyroid gland
The thyroid gland

Let’s start with Thyroid Stimulating Hormone (TSH).

A signal is sent by your brain (pituitary) to your thyroid, signaling it to release thyroid hormone. Your body is smart and always wants to achieve homeostasis, so when your TSH  is elevated, your body is not producing enough thyroid hormone. This happens because your thyroid is failing to produce enough thyroid hormone, and so it's telling your brain to send more signals, in essence, so it can produce enough thyroid hormone.

While the reference changes may differ slightly based on different lab companies, the range is typically anywhere from 0.27 - 4.500. By lab standards, anything above 4.500 would indicate you’re still in a hypothyroid state.

When it comes to optimal TSH values, where we find patients feel their best, their TSH value is ideally 1. We also check your free thyroid hormones, specifically Free T4 (thyroxine) and Free T3 (Triiodothyronine). T4 converts to T3 in the liver, which is your active thyroid hormone in charge of metabolism.

There are several factors that allow for an efficient conversion to happen to T3, some of them being essential nutrients like iron, zinc, iodine, B vitamins, and selenium. T3 is your active thyroid hormone, which is in charge of many of your metabolism processes.

We look at what is called a T3:T4 ratio because there is an optimal range we like to see so that we can make sure your body is converting to enough T3. We like for this ratio to be 3:1. So, for example, a TSH of 1 with a Free T3 of 3 and Free T4 of 1 would be considered optimal.

We also look at your nutrient status to make sure your body has what it needs to efficiently convert to Free T3. The best treatment protocol can be designed for you by addressing all of these factors. There are several different types of thyroid medication, some of which include levothyroxine (T4), allowing your body to convert to T3 on its own naturally. In individuals with optimal nutrient status and lower levels of T3, dual therapy of T4 and T3 may be indicated. 


When it comes to hypothyroidism, you want to assess your blood sugar Some research points to the incidence of hypoglycemia in patients with hypothyroidism, so following a diet that keeps your blood sugar stable throughout the day can make it easier to lose weight.

You can consider tracking your blood sugar throughout the day to see what triggers affect your blood sugar (types of food, stress, sleep or lack thereof, exercise, etc). Often times when it comes to regulating blood sugar, you want to try to incorporate protein, healthy fats, and fiber with all your meals. Incorporating resistant starches (often found in green bananas, cold potatoes, beans, legumes, and oats), can help keep your blood sugar stable. 

Regarding diet, you also want to be on the lookout for any food allergies or sensitivities. It is not uncommon for individuals to categorize foods as “good” versus “bad.” While some foods provide more nutritional value than other foods, what might be healthy for one individual might cause increased inflammation or inability to lose weight in another. This is why testing for food intolerance can be so valuable, especially if you notice that despite your efforts to lose or maintain weight, you still struggle to do so. 

Hashimoto's illustration for post top 10 foods to avoid for Hashimoto's
Hashimoto's Thyroiditis

If you have an autoimmune thyroid condition, like Hashimoto's Thyroiditis, you may want to consider getting tested for celiac disease or even consider following the Autoimmune Protocol (AIP) diet. While this diet can be quite restrictive, it may be prudent to try it for 30-90 days and note whether you experience symptom improvement or an easier ability to lose weight.

There is also a lot of discussion about goitrogenic foods like broccoli, cauliflower, bok choy, cabbage, and brussels sprouts. Goitrogenic foods are foods that disrupt thyroid function. Fortunately, these foods only seem to have an impact when eaten raw and in extremely large amounts. There is no data pointing to the impact these foods have on thyroid function when cooked.

Besides diet and appropriate thyroid treatment, stress is a component that must be addressed when looking to lose weight. Increased stress can cause your body to release excess amounts of cortisol, which is your stress hormone. Your neuroendocrine system is intertwined, and if your adrenals are not functioning properly, it can also throw off your thyroid function.

While your body is extremely intelligent, it cannot distinguish between intense exercise as a stressor versus infection versus work stressors. Finding techniques to help relieve stress, whether it be yoga, meditation, journaling, or walking, can allow your parasympathetic nervous system to be stimulated, allowing your body to shed excess weight. You also want to make sure you are getting adequate sleep, as interrupted sleep and poor sleep habits could have a negative impact on your blood sugar, cortisol levels, and weight. 

Losing weight can be extremely multifactorial, and you want to look at all aspects of your health in order to be able to address the hurdles impacting your ability to lose weight! 

Hypothyroidism and weight gain

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Dr. Linda Khoshaba is the Leading Integrative Health and Hormone Doctor in Scottsdale, Arizona. She has extensive experience working in the field as a Hormone Specialist and Natural Endocrinologist.

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