Is my obesity related to hypothyroidism?

Q: My hypothyroid state was diagnosed when my son was 4 months old. My TSH count at that time was 85.6. It was brought within range through Eltroxin. As on date, my TSH count is 8.65 and FT4 is 0.87. I weigh 73 kgs. No amount of exercising and walks seems to be helping me reduce weight. I suffer from painful knees too. I have become extremely forgetful and it is adversely affecting my personal as well as professional life.

A:There is no doubt that you have primary hypothyroidism. As far as treatment is concerned it is still under treated, as your TSH is still high. The treatment goal for hypothyroidism is to keep TSH under mid normal range. So you need to increase your Thyroxine dose by 12.5 microgram/day.The issue, which you have raised, is weight and hypothyroidism. It’s a myth that patients with hypothyroidism are obese. It is true that there is some weight gain in hypothyroidism but that is to the tune of 5 kg or so and mainly due to water retention and once on treatment it goes away by the time TSH becomes normal. This means that if patient on treatment and TSH levels are normal then obesity is not due to hypothyroidism.One has to look for other causes of being overweight. Most common is lifestyle. I would suggest you to go for more vigorous lifestyle modifications in form of diet and exercise and be consistent with that for a long time. We have some medications also available for weight loss but that has to be taken under supervision only.