The Right Start: Timing Obesity Management for Better Thyroid Outcomes

Dr Shivani Sidana, Associate Professor, Department of Endocrinology and Metabolism, AIIMS, Bathinda 

“Research showed that reducing fat tissue improved thyroid function, indicating that delaying weight-focused therapies beyond substitution treatment in people with thyroid dysfunction was unnecessary.”

Obesity remains a major global health problem in 2022, affecting one in eight people and contributing to cardiovascular and metabolic diseases. Although often blamed on hormonal disorders, obesity was primarily driven by low physical activity and unhealthy eating habits.

Conditions such as insulin resistance and hypothyroidism played a role but were frequently misinterpreted by patients as the main cause of weight gain, leading them to delay necessary lifestyle changes until hormone levels normalized. In reality, hypothyroidism produced only modest weight gain, making it insufficient as a sole explanation for excess weight. Relying exclusively on thyroid hormone therapy often resulted in minimal weight loss and patient frustration, highlighting the need to consider obesity-specific treatments in individuals with abnormal thyroid markers.

Elevated levels of TSH are often observed with weight gain, which could normalize with weight reduction alone. Obesity-related inflammation impaired insulin signaling, altered thyroid hormone production, and increased the risk of autoimmune thyroid disease. Behavioral interventions, such as caloric restriction and moderate physical activity, supported weight control, although the expected weight loss was modest. Incretin-based therapies, particularly GLP-1 receptor agonists, provided substantial weight reduction and cardiovascular benefits without increasing the risk of thyroid cancer. Other pharmacologic options and, when appropriate, bariatric surgery also supported weight management.

A comprehensive, individualized approach is thus essential, combining lifestyle therapy and medications, and, in selected cases, surgery, with thyroid treatment occurring alongside—but not delaying—obesity care. Further clinical trials were needed to refine strategies for patients with uncontrolled thyroid dysfunction and obesity.

(Source: Sutkowska E, et al. When should the treatment of obesity in thyroid disease begin? Biomedicines. 2025 Jan 10;13(1):157. doi:10.3390/biomedicines13010157.; https://pmc.ncbi.nlm.nih.gov/articles/PMC11760466/#sec1-biomedicines-13-00157)