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The dreaded number on the scale. And with conditions such as hypothyroidism or Hashimoto's, it never seems to go down, no matter how much you exercise or changes you make in your eating habits.
Losing weight can be challenging for many living with hypothyroidism, a condition with low thyroid hormone levels. Researchers have shown that a slight change in your thyroid hormone levels can lead to weight gain or even make it hard for you to lose weight. Let’s dive deeper into why this is and learn about a new prescription medication for weight management.
Weight gain, a common symptom of hypothyroidism, occurs when you take in more energy (calories) than your body needs. Your body turns this excess energy into fat and stores it. But this process is way more complex than that, especially involving the thyroid hormone.
Your thyroid gland releases thyroid hormone in response to thyroid stimulating hormone. Thyroid hormone regulates:
- Growth and development
- Metabolism
- Breakdown, storage, and utilization of fat, sugar (carbohydrates), and protein
- Muscle control
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Hypothyroidism is when your thyroid is underactive, meaning it can’t make enough thyroid hormone to meet your body’s demands. How an underactive thyroid causes weight gain or prevents you from losing weight is not fully understood.
However, there are some theories:
- Metabolism slows down
- Feeling tired or lacking in energy leads to a lower activity level
- Changes in how fat and blood sugar are metabolized by your body
- Retention of salt and water in tissues leads to weight gain
Studies have shown after starting thyroid replacement medication with T4, weight loss can occur. However, the amount of body fat stays the same. Researchers concluded weight loss was due to an excretion of excess water and that thyroid hormones can increase your appetite and caloric intake.
As you may be able to tell, losing weight with hypothyroidism is complex. Some have success with the autoimmune protocol diet and/or exercise, while others have not. When diet and physical activity have not been successful, prescription medications such as semaglutide have shown promising results.
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Semaglutide (Wegovy) is the newest FDA-approved medication for chronic weight management. It belongs to a class of medications called glucose-like peptide 1 (GLP-1) receptor agonists. GLP-1 agonists help regulate your appetite and how many calories you eat. Thus, semaglutide causes weight loss by reducing your appetite and food intake, potentially leading to a lower body mass index.
You may have heard that GLP-1 agonists treat patients with type 2 diabetes. This is true. But you don’t have to have diabetes to take semaglutide for weight loss with conditions such as hypothyroidism. Studies show GLP-1 agonists can help reduce body weight in obese patients regardless if they have diabetes. Semaglutide is the second GLP-1 agonist approved for weight management.
Dosing and administration of semaglutide
Semaglutide is a weekly subcutaneous (under the skin) injection. When starting this medication, it is advised to slowly increase your dose until you reach 2.4 mg weekly with the intention of helping to reduce side effects.
Semaglutide is also available under the brand names Ozempic and Rybelsus. However, these brand-name medications are FDA approved for treating diabetes. Dosing for chronic weight loss and diabetes are different.
Most studies have looked at semaglutide as an adjunct to lifestyle modifications to rate its effectiveness in weight loss management and treatment.
A 2021 study included over 1300 participants, each given a weekly subcutaneous injection of 2.4 mg of semaglutide in addition to lifestyle modifications. Results showed that half had an average weight loss of 15% or more from their starting weight. At the end of 68 weeks, participants equated an average 35-pound weight loss from their initial body weight. Even more impressive, about 86% of participants had a weight reduction of 5% or more from their baseline body weight by the end of the study.
A 2020 study comparing weekly semaglutide to daily subcutaneous liraglutide showed a more significant overall weight loss in those that received semaglutide. While the doses were different, these results were echoed in a recent study. The authors of the 2020 study noted liraglutide is a daily subcutaneous injection, whereas semaglutide is weekly, which may have impacted adherence to liraglutide.
The oral medication of semaglutide has been studied for weight loss in adults with obesity showing promising results. However, this formulation is currently not yet FDA-approved as a treatment option for weight management.
Severe nausea and vomiting were the most common side effects reported in clinical studies. One study reported these side effects in over half the participants, with most cases mild. Gradually increasing the dose helps to reduce these side effects.
Other potential side effects can include:
- Diarrhea
- Constipation
- Abdominal (stomach) pain
- Headache
- Fatigue
- Dyspepsia (indigestion)
- Dizziness
- Abdominal distension
- Eructation or belching
- Hypoglycemia (low blood sugar) in patients with type 2 diabetes
- Flatulence
- Gastroenteritis (an intestinal infection)
- Gastroesophageal reflux disease (a type of digestive disorder).
Although rare, acute pancreatitis and cholelithiasis, a gallbladder disorder, can also occur.
Research also suggests there may be a link between semaglutide and thyroid cancer based on animal studies. Semaglutide is not recommended in those with a history of medullary thyroid carcinoma.
No study strictly looked at using semaglutide for weight loss in people with hypothyroidism. But, semaglutide repeatedly showed its effectiveness in causing weight loss in patients with or without diabetes by reducing appetite and caloric intake.
When it comes to health, especially weight loss with hypothyroidism, it is always recommended to address the foundations first. Medications such as semaglutide should be used as a last resort if diet and lifestyle changes have not been implemented.
With conditions such as hypothyroidism, reducing inflammation and implementing a whole-foods based diet can help patients achieve weight loss. If you have yet to implement these, consider meeting with a Paloma Health nutritionist to explore any food sensitivites, or digestive issues that would be worth addressing through diet first.
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