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Should Thyroid Patients Use Topamax For Weight Loss?

Learn if this anticonvulsant medication is safe for off-label use for people with thyroid conditions.
Should Thyroid Patients Use Topamax For Weight Loss?

Julia Walker, RN, BSN

Clinical Nurse

Medically Reviewed by:
Kimberly Langdon M.D.
, last updated: 
November 19, 2021
Medically Reviewed by:
Last updated:
November 19, 2021

 In this article:

 

Weight gain is a common struggle for many people with hypothyroidism and Hashimoto’s disease. And sometimes, getting on a regular regime with your thyroid medication is not enough to help you reach your ideal weight. Thus, many patients with an underactive thyroid search for other options for weight loss help, including diet, exercise, and medication. Ahead, we take a close look at using Topamax for weight loss when you have a thyroid condition.





 

What is Topamax?

 

Topamax (or topiramate) is a medication that falls under the class of anticonvulsants. That is, it primarily helps to treat conditions like epilepsy. However, it is also indicated for use in people with migraines.

 

This medication works primarily on the brain by reducing seizure activity. When a person has a seizure, their brain cells fire very quickly. Topamax helps brain cells operate at a steady pace, preventing them from entering this state of overdrive. For treatment of migraine headaches, this drug also calms overactive pain-signaling that can occur with recurrent migraines. 

 

Topamax is also used for off-label purposes, including treating PTSD, bipolar disorder, anxiety, and weight loss. Off-label use is when a doctor prescribes a drug to treat a condition that is not FDA-approved. For example, doctors can legally prescribe a medication to treat a condition if evidence that the treatment may work and other options have failed. 

 

Does Topamax help with weight loss?

 

People taking Topamax often find that it helps them lose weight. The reason behind this is likely because it curbs your appetite. However, it also may cause your metabolism to speed up. In clinical studies, 6-17% of people taking Topamax have experienced weight loss. Typically, people experience average weight loss when taking this medication. 

 

Sometimes, doctors use Topamax as an off-label treatment option for people struggling with obesity. When used purely for weight loss, people can lose on average around 11 pounds in four months. And, the longer the medication is used, and the higher the dose, the more weight you will lose. Usually, doctors start weight loss patients at a low dose and titrate up as needed while carefully observing for side effects. 

 

What are the potential side effects of using Topamax for weight loss?

Of course, as with any medication, there are side effects. And when it is used for off-label purposes, the risks can be higher. Indeed, this is true for Topamax, where many individuals can experience unwanted effects.

 

Common side effects of Topamax include:

  • Tiredness or drowsiness
  • Dizziness
  • Loss of coordination
  • Tingling of the hands/feet
  • Loss of appetite
  • Bad taste in your mouth
  • Diarrhea
  • Weight loss
  • Mental problems like difficulty with memory

 

More severe side effects may include signs of kidney stones, rapid breathing, irregular heartbeat, bone pain, broken bones, loss of consciousness, or unusual bleeding or bruising.

 

People with the following conditions or medical history should be cautious or avoid using Topamax altogether:

  • Kidney disease
  • Liver disease
  • Lung disease
  • Depression
  • Suicidal thoughts or behaviors
  • Eye conditions like glaucoma 
  • Osteoporosis 
  • Metabolic conditions
  • Pregnancy (unless benefits outweigh risks)

 

Having one of the above conditions puts you at greater risk of adverse outcomes. For example, people who take Topamax and have glaucoma are more likely to worsen their diseases and develop complete blindness. Similarly, those with osteoporosis are more likely to see more bone turnover. Their calcium levels decrease as parathyroid hormone levels decline while on this medication. 

 

Additionally, a comprehensive study of patients with type 2 diabetes taking Topamax found that while study participants did lose weight, they also had an increased risk for severe adverse reactions. Because of the safety concerns surrounding Topamax and the lack of clear guidance on how to prescribe it for weight loss alone, the study concluded that Topamax should be avoided for treating weight loss.

 

Should thyroid patients use Topamax for weight loss?

 

We know that weight gain or difficulty losing weight can be a problem for people with an underactive thyroid. This weight gain can occur because the metabolism is slower when thyroid hormone blood levels are low. It takes longer to burn calories and utilize fat storage. Not only that, the symptoms that accompany an underactive thyroid can be particularly debilitating, making it even harder to exercise. Thus, it is no surprise that many thyroid patients are looking for solutions for getting rid of excess weight. 

 

Take your thyroid medication

One of the best places you can start to curb weight gain with an underactive thyroid is to make sure you are on the correct dose of thyroid medication. To do this, you will need to have a complete thyroid function test that looks at your TSH, T3, T4, and TPO antibodies. You will then want to consult your health care provider to ensure you are on the correct daily dose and address any other concerns. For example, even though some people have thyroid labs within normal limits, they still have thyroid symptoms. 

 

Take your thyroid medication correctly

Next, make sure you take your thyroid medication correctly. Certain habits can interfere with your thyroid medication absorption, including drinking coffee first thing in the morning once you have taken your medication or taking it with specific vitamins and supplements. 

 

Follow a thyroid-healthy diet

The best diet is one that is rich in whole, nutrient-dense foods. Typically, those foods come without a label, like vegetables, fruit, and meat. Following an anti-inflammatory diet can also benefit your thyroid health and weight, especially for people with Hashimoto’s. 

 

Get daily exercise

One lifestyle modification that can support weight loss is finding daily exercise that you enjoy. A complete workout every day is not always feasible between demanding schedules and challenging thyroid symptoms. Fortunately, a little bit every day can add up. Suppose you can find an activity that you enjoy, like dance, aerobics, or swimming. In that case, it is easier to motivate yourself to keep up with that type of exercise. 

 

Other tips for weight loss with hypothyroidism include:

  • Testing for insulin resistance and metabolic syndrome
  • Drinking plenty of water
  • Getting sufficient sleep each night
  • Reducing stress
  • Exploring different weight-loss strategies with a healthcare professional

 

A note from Paloma Health

While Topamax can help with weight loss, it is not the most effective or safe strategy for weight loss in people with thyroid conditions. Currently, no studies look at the long-term effects of using Topamax for weight loss alone, and it is not FDA-approved for weight loss. Furthermore, it can have some serious complications if used in people with certain health conditions. If you have a thyroid condition and are struggling with weight gain, meet with your thyroid doctor to explore the safest and best options for you.

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Julia Walker, RN, BSN

Clinical Nurse

Julia Walker, RN, BSN, is a clinical nurse specializing in helping patients with thyroid disorders. She holds a Bachelor of Science in Nursing from Regis University in Denver and a Bachelor of Arts in the History of Medicine from the University of Colorado-Boulder. She believes managing chronic illnesses requires a balance of medical interventions and lifestyle adjustments. Her background includes caring for patients in women’s health, critical care, pediatrics, allergy, and immunology.

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