How can the symptoms of hypothyroidism be managed?

Written by: Professor Franklin Joseph
Published: | Updated: 27/10/2023
Edited by: Jay Staniland

Hypothyroidism, also known as underactive thyroid disease, is a common disorder that affects approximately 2% of the UK population. More than 5% of those affected are over 60 years old. Women are more likely to experience it than men. With hypothyroidism, your thyroid gland doesn't make enough of the thyroid hormone which can cause challenging symptoms for patients. We recently spoke with the highly experienced endocrinologist Professor Franklin Joseph to discuss the symptoms and how they can be treated.

What are the symptoms of hypothyroidism?


The main symptoms of hypothyroidism are:

  • weight gain
  • feeling low and lethargic
  • dry skin

Weight gain and hypothyroidism


The effects of the thyroid on the metabolism and our bodyweight are complex. Often when the thyroid gland is underactive, and there is a deficiency of thyroid hormones, the body's rate of metabolism becomes slower. The metabolic rate slows down and results in changes in energy balance, causing weight gain. The metabolic rate slows down as a result of an imbalance between the calories consumed and the calories used.


Weight gain is usually more apparent in those with more severe hypothyroidism but also in those whose hypothyroidism is not recognised, diagnosed, or treated in time. Delays in diagnosis can occur as symptoms of hypothyroidism are sometimes non-specific and attributed to the day to-day stresses and pressures of modern-day life. This is because the biochemical changes often become obvious only after a period of time.


Weight gain is also slower and insidious (creeps in gradually) and therefore, it's not recognised as being caused by an underactive thyroid.


Weight loss and hypothyroidism


The weight gain is a combination of fat accumulation and also an excess accumulation of water and salt. Studies have suggested that weight gain due purely to the underactive thyroid is predominantly caused by salt and water retention. Treatment of the underactive thyroid often only results in a moderate amount of weight loss.


In some individuals, weight gain is more apparent. Treating the underactive thyroid to achieve normalisation of the thyroid blood tests does not always result in weight loss an individual hopes to achieve. Once blood tests are in a normal range and other symptoms, other than weight gain, resolve, other strategies to achieve weight loss are likely to be required.


The expenditure of food intake, energy and body weight are controlled by an interplay of several hormones from the thyroid but also proteins and other chemicals. These regulators interact at the brain centres and also regulate energy expenditure and appetite as well as the tissues throughout the body. It's difficult to predict the effect of altering only one of these factors (for example, the thyroid hormone) on body weight as a whole. It's important to recognise the limitation of treatment with thyroid hormone to achieve any further weight loss after the normalisation of thyroid blood results.


What treatment options are available for those with hypothyroidism who would like to lose weight?


Thyroid hormones have been used as a weight-loss tool in the past in patients without any prior thyroid dysfunction. However, this is no longer considered safe as weight loss can result from loss of muscle mass as well as any loss of body fat. There can also be abnormal heart rhythm changes and untoward symptoms of sweating, anxiety and tremors. Longer-term use can cause bones to thin.


Some patients with an underactive thyroid find they have symptomatic improvement with concentration, energy levels and mood when the replacement is at the top end of the normal range. Some do with combination treatment with the T4 and T3 hormone.


Altering the thyroid hormone dose to cause thyroid hormone levels to be elevated and the use of combination T4 and T3 hormone treatment does not tend to have a similar benefit when it comes to weight loss. Patients with hypothyroidism should explore all the options available (including clinically proven weight loss hormone medication) to achieve not just their weight loss goals but any persistent hypothyroid symptoms despite what is considered standard therapy.


If you have hypothyroidism or feel you may have some of the symptoms discussed in this article, you can book a consultation with Professor Franklin Joseph by visiting his Top Doctors profile. 

By Professor Franklin Joseph
Endocrinology, diabetes & metabolism

Professor Franklin Joseph is a consultant physician in menopause and perimenopause, testosterone deficiency, testosterone replacement therapy (TRT), Hashimoto's disease and hypothyroidism in the Wirral and Liverpool

In addition to the areas of expertise mentioned above, he is also highly experienced in diabetes, thyroid, weight loss, diseases of the pituitary and hypothalamus, polycystic ovary syndrome (PCOS) and internal medicine 

Professor Joseph has an impressive educational background, including a Bachelor of Medicine, Bachelor of Surgery (MBBS), an MD, and both an MRCP and FRCP from the the Royal College of Physicians.

In diabetes, he specialises in the treatment and management of both type 1 and type 2. In endocrinology, Professor Joseph looks at pituitary disease, both under and overactive thyroid, adrenal reproductive disorders and metabolic disorders. With obesity, he specialises in the use of all new licensed medical treatments, including the anti-obesity medication Saxenda®.

Professor Joseph leads a successful clinical trial unit that has achieved the highest recruitment figures nationally on studies involving cutting edge therapies for diabetes and its complications. He regularly publishes in peer-reviewed journals.

He is visiting professor at the University of Chester and has been an honorary senior lecturer at the University of Liverpool. He has held various postions in prestigious private clinics, including Chief Medical Officer at DAM Health, and founder and Clinical Lead at Dr Frank's Weight Loss Clinic.

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