Dealing With Weight Loss Plateaus in Hypothyroidism

Changes in diet, exercise, and thyroid treatment can help

Weight gain is common with hypothyroidism (low thyroid function). Even with the best weight loss efforts, people often find they'll shed a few pounds, but suddenly hit a plateau where exercise and diet no longer seem to have any effect. While this is common with anyone trying to lose weight, it can be complicated by hypothyroidism, a condition that inherently interferes with metabolism (the body's ability to convert calories and oxygen into energy).

Fortunately, by better understanding how hypothyroidism affects metabolism and weight, you can take steps to overcome plateaus and stay on track to achieve your weight loss goals.

Weight Gain

As with any weight loss plan, the simple aim is to burn more calories than you consume. This is known as creating a calorie deficit. If one pound of fat contains roughly 3,500 calories, you would need a deficit of 500 calories per day to lose one pound per week. That sounds simple enough.

Unfortunately, with hypothyroidism, your body is less able to metabolize calories. So even if you cut back the calories, you may not be able to burn them as effectively as someone without a thyroid condition.

The cause of this is complex, but it is ultimately associated with a diminished supply of thyroid hormones. The lack may be the result of an impairment of the thyroid gland itself (a condition referred to as primary hypothyroidism) or the impairment of the organs that regulate when and how much thyroid hormones are produced (known as secondary hypothyroidism). All of these can, directly and indirectly, influence weight gain and loss.

The main cause of primary hypothyroidism in the United States is Hashimoto's disease, an autoimmune disorder in which the immune system attacks the thyroid gland. With secondary hypothyroidism, failure of either the pituitary gland or hypothalamus can impede production of hormones that stimulate thyroid activity. Irrespective of the cause, lower thyroid hormone levels almost invariably result in greater weight gains.

With this in mind, weight loss in people with hypothyroidism will involve both a traditional approach to exercise and diet as well as a strategy to correct the hormonal deficits standing in the way of weight loss goals.

Restoring Metabolism

The first step to overcoming a weight loss plateau is to access the state of your thyroid function. Healthcare providers do this by measuring a hormone called thyroid stimulating hormone (TSH). TSH is produced by the pituitary gland and its function is to tell the thyroid gland when to produce thyroid hormones.

When thyroid hormones are high, the pituitary gland can sense this and turn down the TSH production. Conversely, when levels are low—as happens with hypothyroidism—the TSH level will shoot up, providing an indirect but quantitative measure of thyroid function.

Generally speaking, healthcare providers will begin thyroid hormone replacement therapy when the TSH is over 10 milliunits per liter (mU/L) by using a drug called levothyroxine. Levels between four and 10 mU/L are classified as sub-clinical hypothyroidism (low thyroid function without observable symptoms). The problem with this latter definition is that weight gain is still possible in people with sub-clinical hypothyroidism, especially those who are already overweight.

In fact, a 2013 study found a direct relationship between BMI and TSH levels among study participants; as TSH levels increased, so did BMI.

Pharmaceutical Options

What studies like this suggest is that, if you have sub-clinical hypothyroidism and have reached a weight loss plateau despite best efforts, you may want to speak with your healthcare provider about starting levothyroxine therapy. While significant controversy regarding the correct time to start treatment remains, a growing number of healthcare providers believe that TSH levels should not be used in isolation to direct the decision.

If you are on levothyroxine and have reached a plateau, ask your healthcare provider whether an increase in your levothyroxine may help. This is especially important as you get older, as both thyroid function and metabolism tend to decrease with age, or if you've been on the same dose for years but still have trouble maintaining a healthy weight.

You may also want to discuss whether the drug Cytomel (liothyronine) is a reasonable addition to your current therapy. While levothyroxine supplements one type of thyroid hormone (called thyroxine, or T4), Cytomel boosts a more active form derived from T4 (called triiodothyronine, or T3). While many healthcare providers consider Cytomel pointless—since T4 eventually becomes T3—people who take the drug often report an improvement in overall symptoms.

A small study conducted by the National Institutes of Health reported that people prescribed liothyronine lost an average of 0.6 pounds more per week than those on levothyroxine and had an overall 12.1 percent decrease in "bad" LDL cholesterol.

Cytomel is not taken on its own to treat thyroid problems. And, while neither the American Association of Clinical Endocrinologist (AACE) nor American Thyroid Association (ATA) actively endorse the FDA-approved medication, they concede that it may be helpful in some people for whom levothyroxine has failed to provide symptomatic relief.

Stress, Weight Gain, and Adrenal-Thyroid Problems

The adrenal glands also play a role in your thyroid health. They are the organs responsible for the production of the hormone cortisol, the body's main stress hormone associated with the "fight-or-flight" mechanism.

When cortisol levels are persistently elevated, a cascade of adverse symptoms, including high blood pressure, high blood sugar (hyperglycemia), insulin resistance, carbohydrate craving, and weight gain can develop.

Stress—along with the elevated cortisol levels that accompany it—can also play a role in weight gain. In the face of chronic stress, a condition common in today's society, the delicate balance between the adrenal glands and thyroid glands is easily disrupted, triggering a slowdown in metabolism and the potentiation of the weight loss plateau. Functions like digestion, insulin control, and thyroid function may be slowed or temporarily put on hold until cortisol levels come down.

Therefore, in addition to exercising and eating right, you need to take steps to alleviate stress in your daily life. Among the key tips:

  • Make effort to improve your sleep hygiene so that you get no less than eight hours of sleep a night, particular if your TSH levels are elevated. Sleep deprivation is inherently linked to weight gain.
  • Explore mind-body therapies to manage your daily stress, including meditation, gentle yoga, guided imagery, breathing exercises, and progressive muscle relaxation.
  • Limit your intake of caffeine and alcohol.
  • Speak with a mental health professional if you are struggling with chronic anxiety or depression. While antidepressants may help, it is important to note that they are also associated with weight gain—with some having this effect more than others.

Weight Loss Tips

weight loss tactics
Verywell / Emily Roberts

Sooner or later, if you are in the process of dieting, your weight loss will slow down whether you have hypothyroidism or not. It is not that you are doing anything wrong; when faced with the decreased caloric intake, the body will essentially "reset" itself and slow metabolism down. This is especially true in people with a higher body BMI.

Research from the University of Cambridge Metabolic Research Laboratories suggests that the more weight you carry, the greater the chemical signaling in your body to retain the extra weight.

To this end, before placing all of the blame on your thyroid condition, take a step back and accept that a weight loss plateau is simply a call for change. If your metabolism has slowed down, you need to alter your approach to weight loss rather than stick with the same routine.

Among some of the more practical weight loss tips:

  • Increase your workout intensity and duration. Remember that the formula for weight loss is simple: burn more calories than you consume. Most people should exercise for at least 30 minutes three to four times per week. When faced with a plateau, you may need to increase your workouts to one-hour sessions four to five times weekly, incorporating aerobics to get the heart pumping and resistance training to build lean muscle.
  • Change your workout routine. Beyond just amping up the duration and intensity of a workout, change the type of exercises you do. Ultimately, if you do the same routine time and time again, your body will become less responsive to the exertion placed on it. Change things up by swimming instead of running on a treadmill or doing high-intensity interval training instead of static weight lifting.
  • Journal your food intake. Oftentimes, we fail to realize how many calories a little extra topping or salad dressing can add over the course of a week. By journaling everything you eat and drink, you can pinpoint problem spots in your diet and better maintain the calorie deficit you need to reboot your weight loss agenda.
  • Change your diet composition. Instead of trimming calories even further, try increasing or decreasing the percentage of protein, fat, or carbohydrates in your diet to see if it has any impact on your plateau. In the same vein, if you are eating a very low-calorie diet, a slight increase in calories may actually help with your weight loss, as the excessive restriction of calories can often encourage the body to conserve fat.
  • Change your meal routine. If you're on a weight loss plateau, it is often better to eat smaller meals throughout the day instead of three large meals. Make a point of sitting down at a table with plated food rather than eating on the go or out of a bag. You will be better able to control your caloric intake and avoid overeating if you do.
  • Remain positive. Remember that weight loss is a process and not an event. You are not inherently "doomed" to a certain weight if you have a hypothyroid condition. To remain motivated, work with a weight loss support group or participate in group workouts or walks with others hoping to achieve the same goals.

A Word From Verywell

There are no easy fixes when it comes to busting through a weight loss plateau. While hypothyroidism can complicate the condition, there are steps you can take to increase metabolism as your body constantly readjusts to the calories, exercise, and hormones that influence weight.

Before joining any weight loss program, work with your healthcare provider to ensure your thyroid treatment is optimized. Your healthcare provider can also ensure that you approach diet and exercise safely and/or refer you to a nutritionist or personal trainer who can help design an individualized program.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Institute of Diabetes and Digestive and Kidney Diseases. Hashimoto's disease. September 2017.

  2. Cojić M, Cvejanov-Kezunović L. Subclinical hypothyroidism - whether and when to start treatment? Open Access Maced J Med Sci. 2017;5(7):1042–1046. doi:10.3889/oamjms.2017.195

  3. Solanki A, Bansal S, Jindal S, Saxena V, Shukla US. Relationship of serum thyroid stimulating hormone with body mass index in healthy adultsIndian J Endocrinol Metab. 2013;17(Suppl 1):S167–S169. doi:10.4103/2230-8210.119560

  4. Dayan C, Panicker V. Management of hypothyroidism with combination thyroxine (T4) and triiodothyronine (T3) hormone replacement in clinical practice: a review of suggested guidanceThyroid Res. 2018;11:1. doi:10.1186/s13044-018-0045-x

By Mary Shomon
Mary Shomon is a writer and hormonal health and thyroid advocate. She is the author of "The Thyroid Diet Revolution."