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Discussion of 
WEIGHT ISSUES IN GRAVES' DISEASE

Hyperthyroidism increases metabolism, so people with untreated Graves' Disease often lose weight in spite of increased appetite and food intake.  Still, a significant number of patients gain weight instead of losing.  Usually these are the people with milder hyperthyroidism, whose increase in appetite and fatigue-induced decrease in energy expenditure are greater than the increased metabolism.

Following normalization of thyroid levels, many people have much more trouble keeping weight under control than they did before becoming hyperthyroid.  The reasons for this aren't entirely understood, but there probably are many factors.  Many doctors tell us that if our thyroid levels are "normal", any weight gain isn't thyroid-related.  However, the fact that people with treated Graves' Disease do tend to gain weight has been well-documented, and studies have suggested that there may be metabolic reasons for the weight gain.  Hopefully researchers will learn more about this as their work continues.

If treatment for Graves' Disease results in a period of hypothyroidism (which happens especially following radioactive iodine, and often following thyroidectomy), not much can be done to prevent weight gain until thyroid levels are stabilized, except to be careful not to overeat.   Once hormone levels are normalized and our doctors approve a return to exercise (and when our energy levels return), there is a lot we can do to help prevent the weight gain many people experience.  It depends on how motivated one is to make it work.

Hyperthyroidism, especially when it's severe or has gone untreated for a long time, causes wasting of muscle tissue, and this muscle is rebuilt when thyroid levels are normalized.  The restoration of muscle tissue is part of the weight gain resulting from treatment for hyperthyroidism.  This new muscle tissue is of lower quality than what was lost, so exercise (especially weight training) helps to restore normal muscle tone.  Since muscle burns more energy at rest than do other parts of the body, rebuilding normal muscle strength and tone is helpful for weight control.

Another factor in weight gain following Graves' Disease treatment is that some people lose their perspective on what "normal" eating is, especially if they've been eating everything in sight without gaining weight while hyperthyroid.   Try writing down everything you eat for a week or so, and take an honest look at the caloric and nutritional content.   Also, watch how thin people really eat.  It might surprise you how little most people can eat without gaining weight (unless calories are burned through exercise).   If you try this and still can't lose, consult a nutritionist who is experienced with thyroid disorders.

Optimizing thyroid replacement hormone may also help some people increase metabolism and regain the energy to lead an active life, which can be a helpful factor in long-term weight control.

For me, cutting down food intake to the level needed to keep from gaining weight after G.D. treatment simply doesn't work long-term.   If I slip up even for one meal, I always have to "wear it".   Realizing that something is wrong metabolically is no comfort at all when my clothes are too tight. 

The only answer left for me is to increase energy expenditure.  I work out with weights regularly 3 times a week for at least 45 minutes each, and during the winter add 45 minutes of aerobic activity to that.  During better weather I ride my bicycle as much as possible.  We take our bicycles on vacation when possible, and on days we do long rides (40-65 miles) I can eat very well!  (Bike fuel, you know.)  :-)   We also ski during the winter, and I walk a considerable amount in my job as a mail carrier.  It all adds up, and if I'm careful, I can keep the weight off without restricting my diet unrealistically.    Hopefully you will find what works for you, too!

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