Diet and Weight Loss Tips for Thyroid Patients

Losing weight can be a frustrating process for many people with an underactive thyroid. Whether you have hypothyroidism or no thyroid after surgery or radioactive iodine (RAI) treatment, there's no question that for many, the thyroid affects metabolism and can make weight loss an uphill battle.

Here are some surprising tips that can help you finally tackle your weight loss frustrations and get on track, as well as several diet and weight loss secrets to help you win the battle against excess pounds.

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Illustration by Emily Roberts, Verywell 

Get a Diagnosis as Quickly as Possible

If your thyroid is underactive, a lack of treatment, or insufficient treatment, may make weight loss almost impossible, despite diet and exercise. And the longer it takes you to get diagnosed, the more weight you could gain.

While you're becoming hypothyroid, even before your TSH is elevated enough to warrant treatment, your metabolism can slow down significantly, causing you to burn fewer calories each day. Hypothyroidism can also make you tired, achy, and less likely to exercise, further reducing your metabolism. And, when you’re tired, you may eat more sugary foods and carbohydrates for energy.

If you have symptoms of thyroid disease, see your doctor right away and get informed about the diagnosis and treatment process.

Look Into Optimal Treatment

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In terms of weight loss, relief of symptoms, and overall good health, for many thyroid patients, it's not enough for your doctor to diagnose hypothyroidism and hand you a prescription. More than standard treatment, you may need optimal treatment to ensure that your cells are getting the oxygen and energy they need to allow your metabolism to do its job.

By the Numbers

  • Typically, your thyroid-stimulating hormone (TSH) is less than 2.0
  • Your free T3 is in the top half of the reference range
  • Your free T4 is in the top half of the reference range (unless you're on a T4/T3 medication, in which case it can sometimes be lower)

Just because your numbers are in the normal reference range doesn't mean that they're optimized for you personally. Everyone is unique and you may need a different level than someone else.

If you're still experiencing symptoms, it's time to have a conversation with your practitioner about optimal hypothyroidism treatment. And if your doctor is only interested in getting you to the "normal" range, then it's time for a new doctor.

Have Your Hormone Levels Tested

Research shows that hormone resistance problems—including leptin resistance and insulin resistance—contribute to the difficulties many thyroid patients face in losing weight. And since both hyperthyroidism and hypothyroidism have been shown in multiple studies to create insulin resistance, this means you should consider having your fasting glucose and leptin levels tested, evaluated, and treated.

Fasting glucose levels above 90 may be a sign of insulin resistance and pre-diabetes, which can make weight loss even more difficult. For very high levels, your doctor may prescribe a type 2 diabetes drug like Glucophage (metformin). For borderline levels, reducing the sugar and carbohydrates in your diet and following a healthy carbohydrate-controlled diet can lower your blood sugar and help with weight loss.

Consider Hyperthyroid Treatment Options Carefully, Too

You'll need to think about whether to have RAI versus other hyperthyroidism and Graves’ disease treatments. Weight gain after RAI is common. One study on patients who had a thyroidectomy found that those who did the surgery as their first line of treatment were less likely to become overweight or obese than those who had undergone RAI first. Talk to your doctor about your Graves’/hyperthyroidism treatment options.

Keep in mind that most patients who have had surgical removal of the thyroid, called a thyroidectomy, or radioactive iodine (RAI) treatment end up with hypothyroidism. There can be a delay between your treatment and the start of thyroid hormone replacement medication, leaving you hypothyroid for an extended period.

Have a plan in place with your physician for regular thyroid testing after surgery or RAI so that your treatment can start as soon as there is evidence that you are hypothyroid.

Change Your Diet

There is no one best thyroid diet, but making a significant change to how you eat is usually necessary in order to successfully lose weight when you have a thyroid condition. What type of diet to follow, however, depends on your unique physiology, food sensitivities, ability to absorb nutrients, and how effective your body is at metabolizing, storing, and burning carbohydrates, among other factors. The key is to try different ways to lose weight, and when you find something that's working, stick with it.

Some approaches to consider include:

  • Cutting overall calories: Use a calorie calculating app on your phone or computer to track everything you eat and drink.
  • Upping your fiber intake: Getting a good amount of fiber is one of the basic tactics you can employ as a thyroid patient if you want to lose weight. It can come from high-fiber foods, supplements, or both.
  • Watching out for foods that slow down thyroid production: Avoid overconsumption of thyroid-slowing raw goitrogenic foods and vegetables like kale, spinach, and broccoli. Consider passing on raw juice diets in particular.
  • Limiting simple carbohydrates and sugar: Try following a low-glycemic diet.
  • An anti-inflammatory diet: The autoimmune protocol/anti-inflammatory/AIP diet may be a good option to consider.
  • The Paleo diet: An unprocessed, low-sugar, whole foods diet, the Paleo diet, can reduce inflammation. Just make sure you're getting enough iodine.
  • A low-carbohydrate diet or very low-carbohydrate diet: Examples include the ketogenic diet and the Atkins diet. 
  • Changing the timing of your meals: Try the intermittent fasting diet. Another approach that may be effective is the "mini-meal"/grazing-all-day approach to eating. Limiting your eating to two or three meals per day with no snacks and no food after 8 p.m. may help stimulate fat burning and help regulate hunger hormones.
  • Getting tested for food allergens: Common allergens include dairy, wheat, soy, and certain fruits and nuts. If you find you have allergies to any of these, work to eliminate them from your diet.
  • A gluten-free diet: There's a link between gluten sensitivity and celiac disease and the development of autoimmune conditions, including Hashimoto's thyroiditis. Some patients have reported significant weight loss when they shifted to a gluten-free diet.

Try eating gluten-free for three months. If you notice less bloating, more energy, and you lose some weight, this is a good sign that eliminating gluten is a helpful weight loss approach for you.

Hydrate

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Water helps your metabolism work more efficiently. It can also help reduce your appetite, eliminate water retention and bloating, and improve elimination and digestion.

You may know about the common recommendation to drink eight 8-ounce glasses a day, but some experts suggest that you drink another 8-ounce glasses for every 25 pounds of weight you need to lose.

Philip Goglia, author of Turn Up the Heat: Unlock the Fat-Burning Power of Your Metabolism, recommends that you drink one ounce of water per pound of scale weight. For most people, this ends up being a great deal more than the standard 64 ounces a day. If you're at a plateau, or your weight loss is very slow, it's worth trying.

Try Metabolism-Boosting Exercise

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For many thyroid patients, calorie restriction or even a diet overhaul isn't enough to allow for weight loss. Hypothyroidism can lower your metabolism, which means you need fewer calories, making it more difficult to cut enough calories to generate significant weight loss.

One of the most important things you can do to raise your metabolism is exercise. Working out helps make your metabolism more efficient by burning calories and fat, reducing blood sugar levels, and balancing weight-loss promoting hormones such as leptin.

If you want to lose weight, you're going to need to do more exercise than you might expect. According to the Centers for Disease Control and Prevention (CDC), healthy people of normal weight need at least 150 minutes of moderate physical activity or 75 minutes of vigorous activity (or some combination of the two) every week to maintain weight and avoid excess gain. If you're hypothyroid and want to lose weight, you may need to do more than an hour a day of exercise.

Some thyroid patients highly recommend a muscle activation and muscle-building DVD workout program called T-Tapp. Other patients have found walking, Pilates, lifting weights, and other forms of exercise effective.

If you have to prioritize which type of exercise to do, consider strength training and exercise that builds muscle for the maximum metabolic benefits.​

Familiarize Yourself With Your Medications

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Some of the drugs doctors prescribe for your thyroid-related symptoms or other conditions you might have can cause weight gain. For example, the following medications are associated with weight gain:

  • Antithyroid drugs such as Tapazole (methimazole) and PTU (propylthiouracil), used to treat Graves’ disease and hyperthyroidism
  • Beta-blockers, like Sectral (acebutolol), Tenormin (atenolol), and Corgard (nadolol), which are often used to treat hyperthyroidism
  • Steroid anti-inflammatories such as prednisone
  • Estrogen and progesterone, either alone or together in hormonal birth control or in hormone replacement therapy
  • Certain antidepressants, especially Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline)
  • Mood-stabilizing and anticonvulsant drugs such as those given for bipolar disorder, including lithium, Depakote (valproate) and Tegretol (carbamazepine)

If you're on any of these medications and you're gaining weight, talk to your doctor about your concerns. Never stop taking a medication without your doctor's input.

Get Enough Sleep

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One of the most important things that you can do to help weight loss is get enough sleep. Numerous studies link sleep deprivation to a slowed metabolism and obesity. Not getting enough sleep may also make you more vulnerable to developing heart disease or diabetes.

Some practitioners have recommended that you even skip a morning workout and use the time to get more sleep. So, if weight loss is a challenge, aim for seven or more hours of sleep every night (good advice, no matter your health goals).

A Word From Verywell

If you feel like you've been doing everything right and you're frustrated by the scale refusing to budge, here's one last diet tip: Don't give up! Regroup and start troubleshooting your diet and weight loss program by finding out more about how to bust through a weight loss plateau and exploring more tips for thyroid patients on making your diet work for effective weight loss. Consulting with a registered dietitian and a fitness trainer may also be helpful.

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