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Why Do Some People With Hypothyroidism and Hashimoto’s Experience Weight Loss?

Weight gain is common in those with hypothyroid conditions. And while most people with hypothyroidism and Hashimoto’s Thyroiditis have a difficult time losing weight, a small percentage of people with hypothyroid conditions find it challenging to gain weight. In this article I will discuss the common factors which cause some people with hypothyroidism and Hashimoto’s to experience weight loss and/or find it difficult to gain weight.

Before I talk about some of these causes, keep in mind that the focus of this article will be on those factors which can result in “extreme” weight loss. But what is considered to be “extreme” weight loss? Well, some sources consider a weight loss of greater than two pounds per week to be extreme. This is especially true if the weight loss occurs without dieting, but even if you are dieting it can be unhealthy to lose too much weight too fast. Other sources claim that losing over ten percent of your body weight in a period of 6 months is a cause for concern.

Are There Risks Of Losing Too Much Weight?

I realize that many people with hypothyroidism would love to have the problem of losing too much weight. But without question there are risks of losing an excessive amount of weight. Many reading this know that in the past I was diagnosed with Graves’ Disease, and at the time I lost over 40 pounds. Earlier I said that losing over ten percent of your body weight over a six month period of time is a cause of concern, and in my case I lost over 20% of my body weight in that period of time. And while everything turned out okay, the following are some of the risks of extreme weight loss (1):

  • Excessive loss of lean body mass
  • Decrease in bone mineral density
  • Water and electrolyte problems
  • Increased risk of forming gallstones
  • Mild liver dysfunction
  • Elevated uric acid levels

With that being said, I’d like to go ahead and discuss some of the common causes of extreme weight loss. Although I will briefly talk about diet, the truth is that if someone with hypothyroidism is losing a lot of weight, then there is a good chance that something besides diet is responsible for this. This is especially true if they are rapidly losing weight over a prolonged period of time. But of course everyone is different, and sometimes it can be challenging to determine the cause of the weight loss.

Weight Loss Cause #1: Following an autoimmune Paleo diet. As I mentioned in the previous paragraph, dietary changes alone usually won’t result in extreme weight loss over a prolonged period of time. But every now and then I will consult with a patient who is losing a lot of weight as a result of following a strict diet. In most cases this isn’t a concern, as while following an AIP diet sometimes can result in a good amount of weight loss initially for some people, this usually doesn’t occur for longer than a few weeks, although there of course are some exceptions.

Weight Loss Cause #2: Taking too high of a dosage of thyroid hormone medication. This isn’t something I commonly see, but I have worked with a few patients who became temporarily hyperthyroid by taking too high of a dosage of thyroid hormone medication. If you are taking thyroid hormone medication and are experiencing hyperthyroid symptoms, then there is a good chance that weight loss can be attributed to the high thyroid hormone levels, although I of course would recommend getting an updated thyroid panel to confirm this.

Weight Loss Cause #3: “Switching” to a hyperthyroid state. Although I just gave an example of “medication induced” hyperthyroidism, it’s also possible for someone with hypothyroidism or Hashimoto’s to switch to a hyperthyroid state without it being caused by taking high doses of thyroid hormone medication. For example, it’s possible for someone to have the antibodies for both Hashimoto’s Thyroiditis and Graves’ Disease. And while I find it’s more common for people to switch from a hyperthyroid state to a hypothyroid state, the reverse can be true as well. Sometimes taking other medications such as Amiodarone can induce hyperthyroidism. Amiodarone is an antiarrhythmic drug, and since it can also cause hypothyroidism it rarely is given to people with hypothyroid conditions.

Weight Loss Cause #4: Having a gut infection. Not all gut infections will result in weight loss. But some infections that can cause weight loss include certain types of parasites such as Blastocystsis hominis and giardia, viruses such as Rotavirus, as well as bacterial infections such as Yersinia enterocolitica.

Weight Loss Cause #5: Small intestinal bacterial overgrowth (SIBO). Although not everyone with SIBO loses weight, many people do. An overgrowth of bacteria in the small intestine is a common cause of malabsorption, which in turn can lead to weight loss. In addition, many people with SIBO are on a very restrictive diet to help manage their symptoms, and so this can also be a factor in the weight loss.

Weight Loss Cause #6: Inflammatory bowel disease. Both Crohn’s disease and ulcerative colitis can result in weight loss. The main reason for this is due to malabsorption.

Weight Loss Cause #7 Other causes. In addition to the causes listed here, there can be other factors that cause extreme weight loss, including Celiac disease, diabetes, Addison’s disease, and cancer.

How Do You Find Out The Cause of This Problem?

If you are experiencing extreme weight loss that’s not related to dietary changes then it can sometimes be challenging to know what the cause of the problem is. And sometimes you might think you know what the problem is, but then later on learn that something else was responsible for the weight loss. For example, I’ve had numerous patients with hypothyroidism and Hashimoto’s Thyroiditis lose a lot of weight and attribute it to following a strict AIP diet, but then eventually find out that they had a gut infection, or a different problem. And so here are some things to consider in order to determine what the cause of the weight loss is:

  1. Do an updated thyroid panel. If you are experiencing extreme weight loss then it’s a good idea to do an updated thyroid panel, consisting of the TSH, free T4, and free T3. If the thyroid hormone levels are elevated then hyperthyroidism is a likely cause of your weight loss problem.

  2. Get a CBC with differential. Although a complete blood count with differential won’t detect specific infections, if someone has white blood cells, neutrophils, and/or lymphocytes that are out of range then this can be a sign of an infection. Other markers can also give some important clues. For example, while elevated eosinophils are usually due to allergies, they can also be related to parasites.

  3. Consider doing a comprehensive stool panel. A comprehensive stool panel can help determine whether you have parasites or a pathogenic infection, which in turn can be responsible for the weight loss. Just keep in mind that while a comprehensive stool panel is probably the best way to detect parasites, false negatives are a possibility. In addition to testing for parasites, the comprehensive stool panels of many companies test for markers that can give an indication if someone has inflammatory bowel disease. One of the most common inflammatory markers tested is calprotectin. To learn more about this marker please read my blog post entitled “Breaking Down The Different Markers of Inflammation”.

  4. If SIBO is suspected then do a breath test. Recently I wrote a detailed blog post on SIBO that I would recommend checking out. In the post I not only mentioned some of the common symptoms people with SIBO experience, but I also discussed breath testing, which is used to measure hydrogen and methane gases. High levels of these gases are associated with an overgrowth of bacteria in the small intestine.

  5. Consider other types of testing. I mentioned that Celiac disease can be a cause of extreme weight loss, and so you can consider doing a Celiac panel, or if necessary you can consider scheduling an appointment with a gastroenterologist. I mentioned Addison’s disease as a possible cause of extreme weight loss, and testing for cortisol and ACTH can help determine this. Cancer is also a possibility, and this is especially true if the extreme weight loss has been happening for a prolonged period of time. Sometimes a CBC with differential can give an idea if someone has cancer, although in most cases further testing is necessary.

What Can You Do To Gain Weight?

Of course in order to gain weight the first thing you need to do is figure out why you are losing weight. And I just spoke about some of the things you can do in order to figure this out. Sometimes the solution is easy, which is the case when it’s related to following a strict autoimmune Paleo diet, or taking too high of a dosage of thyroid hormone medication. On the other hand, other times it can be challenging. Having a gut infection, a condition such as small intestinal bacterial overgrowth, or inflammatory bowel disease can be more of a challenge to deal with, although even in these situations it is possible to either address the cause of the problem, or at the very least manage the symptoms.

And while nobody wants to consider scenarios such as having cancer or other scary conditions, sometimes it is necessary to rule these conditions out. This is especially true if other tests I mentioned came out negative. Another scenario is if the CBC shows abnormal findings of the white blood cells.

So hopefully you have a better understanding as to some of the factors which can cause weight loss in those with hypothyroidism and Hashimoto’s Thyroiditis. Some of the causes of weight loss include following a strict autoimmune Paleo diet, taking too high of a dosage of thyroid hormone medication, becoming hyperthyroid due to other reasons, having a gut infection, SIBO, or inflammatory bowel disease. Finding the cause of the weight loss can sometimes be challenging, and some of the tests that might be helpful include a thyroid panel, a CBC with differential, a comprehensive stool panel, a SIBO breath test, a Celiac panel, and other types of testing might need to be considered in certain situations. In order to gain weight you of course need to first determine the cause of the weight loss.

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