I Can’t Figure Out Why I Can’t Lose Weight

I don’t want to sound like I’m beating a dead horse but I thought writing another article in an attempt to clarify thyroid issues might be in order. Additionally, an article discussing weight issues right before we kick off the holiday season might be beneficial to some of my readers.

Since I wrote the August 2013 article entitled “My Thyroid Is Low But My Doc Doesn’t Know”, I have seen many patients who have thyroid hormone concerns. I try to have them visit before their consultation as this website does an admirable job of discussing many of the issues and symptoms shared by my patients.

During a typical consultation I will go over some of the hallmark symptoms associated with decreased thyroid function. The major symptoms can include fatigue, depression, inability to lose weight or weight gain, changes in hair, skin, and nails, cold intolerance, fibromyalgia, constipation or bowel function irregularities. Then I ask the patient to tell me about the symptoms they experience and I listen to their response.

My grandfather received his Texas medical license on May 20th, 1946. His license to practice medicine expired in 1996 upon his retirement. During his 50 year history as a general practitioner he treated numerous patients with the symptoms listed above. His medical office was a part of his house and when he wasn’t inviting patients into his house he was visiting them in theirs. He talked to his patients and then his listened. Why? Lab tests during the majority of his practice were more expensive and the results took longer than they do now. He didn’t order labs without first having a few possible diagnoses in mind knowing that if the patient was very sick, the results might come back after the patient was already dead! He practiced medicine at its finest. If a patient described a few of the above symptoms consistent with low thyroid he often wouldn’t order a lab test at all. He had the diagnosis of hypothyroidism and increased thyroid replacement (he used Armour thyroid) until the patient’s symptoms improved and they got better.

Now? We order a simple thyroid screening test called TSH. The problem with any screening test is that they are designed to screen for possible disease that might go unreported. Screening tests were NEVER designed to be used on patients that reported symptoms. “Sorry ma’am. I know that you thought your thyroid wasn’t working properly but I checked your TSH and it came back normal. You just need to stop eating so much!”

I have lost count of the weight loss patients that had a normal TSH and knew they had thyroid problems that responded well when I put them on the same medication that worked well for my grandfather 65 years ago.

How much medication is enough? Most people need between 120-180mg of natural thyroid (Armour) or 200-300mcg of synthetic thyroid (Synthroid/ levothyroxin). If you have ever been diagnosed with hypothyroidism or borderline thyroid function and are on medication- take a look at your bottle. Odds are you are underdosed and STILL HAVE SYMPTOMS.

Why would you have symptoms if your thyroid is just borderline? Your doc is doing exactly what they were trained to do. Check the TSH (never intended to be used for someone with hypothyroidism) and keep it in the normal range. TSH isn’t a thyroid hormone. It’s a brain hormone (think gas pedal) that asks the thyroid to release more T4 and T3. What if there is a blockage in the fuel filter? It doesn’t matter where the gas pedal is- you need to check the tachometer to see how fast the engine is turning (free or circulating T4 and maybe T3). Total T4 and T3 aren’t good tests either. T4 and T3 are bound (made unavailable) by thyroid binding globulin.

My wife (board-certified OB-Gyn who takes Armour thyroid) said it best. “It doesn’t matter if you use a high dose, medium dose, or mini-pill for birth control. They all suppress normal hormone release. The thyroid behaves just like the ovaries! Too little thyroid replacement is as bad or worse than no thyroid replacement. If thyroid hormone is low you need to give the body what it needs!”

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. Stay tuned for an article about the Big “O”! Comments or questions? His email address is: