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Subclinical hypothyroidism is not an important cause of weight gain
Sunday, March 28, 2004 1:19 am Email this article
"Subclinical hypothyroidism is not an important cause for weight gain or obesity," concluded researchers from the Centre for Obesity Research in Luton and Dunstable Hospital in Luton, United Kingdom.
Resting metabolism was found to be 9 percent lower in patients with subclinical hypothyroidism than in controls (1256 versus 1375 calories per day, respectively).
Calorie intake was also lower, 5 percent lower in those patients than in controls (1879 versus 1969 calories per day, respectively), however the difference was not statistically significant.
Treatment with T4 thyroid hormone for six months normalized thyroid levels, however, it had no effect on resting metabolism, no effect on calories consumed, and no effect on body weight.
Subclinical hypothyroidism was defined as having a Free T4 levels of 10 to 14 pmol per liter and moderately elevated thyroid stimulating hormone (TSH) of 5.5 to 12 mU per liter.
Sheikh M, Kong WM, Ward T, Finer N. Energy balance in subclinical hypothyroidism: No predisposition to obesity. International Journal of Obesity, 1999 May, 23(5):S82(abstract 230).
Articles on the same subject can be found here:
On Oct 12, 2004 at 5:00 pm Julie wrote:
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I am a woman who gained approximately 80 pounds in less than 3 years, prior to being diagnosed with hypothyroidism. My BMI increased from 22 (normal) to 34 (obese). My weight gain ceased abruptly (in the first week) upon beginning thyroid hormone therapy, and has never again been a problem in the six years since I was diagnosed. However, I did not experience any spontaneous weight loss as a result of therapy. I have only been able to lose about 25 pounds, and that only because of careful dieting. My TSH at time of diagnosis was 13.3, only slightly higher than the limit for this article, and my T4 level was within the normal reference range.
This article seems to display a common error of logic concerning weight gain during hypothyroidism--If an overweight patient with hypothyroidism does not lose weight upon beginning thyroid therapy, his overweight was not caused by low thyroid function. However, since thyroid therapy is only expected to restore normal metabolism, and normal metabolism does not cause spontaneous weight loss, the error in this reasoning seems obvious. While I do not think MOST obese people have a thyroid problem, anyone who is experiencing unexpected, unexplainable weight gain should certainly consider the possibility. Thank you.
On Oct 17, 2004 at 1:01 pm Larry Hobbs wrote:
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Thank you for sharing your story. I agree with you.
I think that metabolism is a very important part of weight maintenance.
The impression I get from the literature is that most researchers do not recognize or appreciate the impact of low metabolism -- even a couple hundred calories per day -- on weight maintenance.
This difference in metabolism is the equivalent of walking a couple of miles per day.
This is one reason that smokers tend to be thinner than non-smokers; nicotine stimulates metabolism.
Studies have repeatedly found that obese people have lower metabolism when calculated per pound of lean body mass (muscle).
A number of studies have found that, for example, a 300 pound person has a higher metabolism than a 200 pound person, and therefore have mistakenly concluded that metabolism isn't the problem.
Studies have also found that people who used to be obese have a lower metabolism than people of the same weight who were never obese, yet most obesity researchers do not recommend giving thyroid to these patients.
My guess is that many of them secretly believe in the idea, but don't want to stray to far from the herd which would cause them to be seen as a "quack".
I think that many years ago main stream medicine threw out the baby with the bath water when they recommended that doctors stop using thyroid to help patients lose weight.
The problem was that they were given large doses of thyoid for weight loss which caused people to lose large amounts of muscle and caused heart problems in some patients.
However, this does not mean that small amounts of thyoid are not useful or are not safe -- I believe that they are.
I know of at least one very successful doctor -- and I imagine there are many more around the country -- who gives his weight loss patients a small dose of thyroid to help maintain their metabolism after losing weight.
I agree with this practice.
On Oct 17, 2004 at 1:20 pm Larry Hobbs wrote:
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The type of thyroid given is probably also important.
Many doctors give Synthroid (containing T4 only), however, a couple of doctors who I have a great deal of respect for -- Jonathan Wright, MD, and Ward Dean, MD -- say that natural desiccated thyroid, which contains both T4 and T3 (such as Armour Thyoid), is better.
About 10 years ago (approximately 1994), there was a 30 minute program on thyroid on the now defunk channel called American Medical Television. Several thyroid experts were on the program and every one of them recommended giving Synthoid (T4 only). None of them recommended T4 plus T3 (natural desiccated Armour Thyroid).
The idea behind giving Synthroid (T4 only) is to let the body convert T4 to T3 as necessary.
(T4, which contains 4 atoms of iodine, is converted to T3, which contains 3 atoms of iodine. An enzyme, which acts like chemical scissors, removes 1 iodine atom to make this conversion. T3 is more active in the body than T4. Some people have said that T3 is 4 times more active than T4, while others say it is 10 times more active. T4 is sometimes referred to as the storage form of thyroid hormone in the body, while T3 is the active form.)
I think that the idea of using Synthoid (T4 only) came from years of research funded by the drug company selling Synthroid (T4) in order to promote sales of their product.
However, Dr. Jonathan Wright has said that "Synthroid, or synthetic thyroid, has undesirable side effects in most people."
Dr. Ward Dean has said...
"Synthroid, the most commonly-prescribed hormone for hypothyroidism, contains only one fraction of thyroid hormone - T4.
"T4 is normally converted by the body into T3, the active form. I believe that many hypothyroid patients are unable to efficiently perform this conversion.
"Armour thyroid, on the other hand, is a desiccated preparation of porcine thyroid, containing all thyroid hormone factors - T2, T3, and T4.
"I have found that it is very difficult to provide adequate thyroid supplementation with Synthroid without causing patients to become thyrotoxic.
"On the other hand, most patients who switch from Synthroid to Armour thyroid, report that they feel much better with the Armour product.
"The dramatic improvements that many of my patients have achieved on thyroid therapy often appear miraculous.
"It is very gratifying to hear a patient who has suffered for decades express how their lives have been totally turned around by a few cents worth of thyroid.
"Unfortunately, most physicians have been bamboozled by the manufacturers of synthetic thyroid hormone (Synthroid) into thinking that the Armour thyroid product is an inferior, non-standardized drug. Nothing could be farther from the truth.
"In fact, a recent study confirmed the efficacy of the Armour product compared to synthroid."
Dr. Ward Dean has also said...
"Treatment of subclinical hypothyroidism with thyroid hormone is very safe.
"There is little risk of excessive thyroid dosage if:
"(1) the patient feels well;
"(2) the temperature remains below 98.2;
"(3) the pulse is less than 75 beats per minute; and
"(4) the thyroid function tests remain normal.
"(Note that most hypothyroid patients feel best with sub-normal TSH levels)."
Because of Dr. Wright and Dr. Dean, I also believe that natural desiccated thyroid such as Armour Thyroid (T4 plus T3) is superior to Synthroid (T4 only).
On Oct 25, 2004 at 11:17 am Julie wrote:
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Thank you very much for your response to my comments. I thought you might be interested to know that when I began noticing symptoms of hypothyroidism, I was a "formerly-obese" person. I had lost 60 pounds-from 195 to 135, 9 years earlier at the age of 20, after having been an overweight child and teen since about age 6. I surmise that my natural tendency toward overweight made the impact of the thyroid problem on my weight more severe than it might have been if I were always slender. After all, maintaining a reduced weight for many years requires regular habits of eating and exercise, and I was thrown for a loop when my normal weight-maintenance routine slowly stopped working. Everything I thought I knew about my health and my weight suddenly appeared to be all wrong, yet my doctors were still telling me that nothing at all had changed in my physiology.
I am now taking both synthetic T4 and T3, although T4 was all I took when diagnosed, and it was sufficient to halt my rapid weight gain. Although I can't tell if the T3 I take helps with my weight control efforts, it does seem to make me feel less muscle/joint pain than I had with T4 alone, and it has returned my blood pressure to normal when T4 alone did not. Thanks again for your interest in my case and for your excellent website.
On Oct 26, 2004 at 2:59 pm Larry Hobbs wrote:
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Thank you for your nice comment. I appreciate it.
Note that Dr. Wright and Dr. Dean say they prefer natural desiccated thyroid, such as Armour Thyroid, to synthetic T4 (Synthroid).
They don't say they prefer giving synthetic T3 along with synthetic T4, but instead say they prefer natural desiccated thyroid, such as Armour Thyroid.
I believe that Dr. Wright or Dr. Dean have also said that natural desiccated thyroid, such as Armour Thyroid, may also have other ingredients, such as T2, which might also have positive effect in the body.
If it were me, I might try Armour Thyroid instead of synthetic T3 plus synthetic T4 and see if I felt any better.
Although T3 is not recommended for weight loss, I have seen a couple of studies from South America in which they gave women 25 mcg of T3 three times per day in addition to a 1200 calorie per day diet and the women lost 11.9 pounds compared to 8.5 pounds for women given a placebo.
The reason T3 is given several times per day is because it has a short half-life.
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