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September 26, 2005

Thyroid, Weight and Weight Loss

Question from Stockbridge, Michigan, USA:

My 15 year old daughter has had type 1 diabetes for three years. Everything went well until she was diagnosed with hypothyroidism two years ago. She is very active and athletic. She eats a low fat diet and her blood sugars are very good. But, she cannot seem to lose the 10 to 15 pounds she has gained since being diagnosed with the hypothyroidism. Her TSH levels are in good range. She is taking 100mcg of Levoxyl daily and her dosage has been increased once. Her weight gain seems to be primarily in the abdomen, with a bloaty or edemic look throughout the body. What can we do to help her lose the weight? Could something else be wrong? Being a young teenager, this bothers her tremendously. Also, she does complain of swelling, stretch marks, and irregular menstrual periods.

Answer:

If the thyroid blood levels remain normal and she is faithful and not forgetting thyroid pills intermittently (you can ask the pharmacy to do a pill count for you – should be using 90 pills in 90 days, for instance) – then this is not likely a thyroid related problem. If the kidney function and heart function is normal, then this is not fluid retention. If the A1c is less than 7%, then this is also not likely related to glucose control. I would wonder about adrenal function and adrenal insufficiency (Addison’s) and also celiac disease. Both can be checked with adrenal antibodies and cortisol levels for Addison’s and with a transglutaminase antibody screen for celiac. Both could cause fluid retention. In severe forms of both, there would be many other symptoms, but sometimes these are subtle and, in less severe forms, can be asymptomatic. I’d go back and ask specifically for tests for these two conditions and then work with your diabetes team closely to try to figure this out.

If there is reasonable daily activity and if all the testing is normal, then the most common cause for unwanted excess weight still remains subtle excess food. A 24 hour diet recall and analysis will usually point out where the high portions and/or high fat content is occurring.

SB