How can I lose weight if I have hypothyroidism?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Friday, it's Dr. Melina Jampolis, a physician nutrition specialist.

How can I lose weight when I have hypothyroidism and I can't do strenuous exercise? My doctor is still adjusting my thyroid medication, so my TSH (thyroid-stimulating hormone) is still high at 22. Added to that, I've got heart problems and have been told by my cardiologist not to do strenuous exercise! I do a lot of walking and typically do 10,000 steps a day. I've been doing a low fat 1,400 calorie diet with no result. I was thinking about a low-carb 1,200 calorie diet and upping my steps to 15,000 a day but I'm wondering what else I can do when I can't exert myself.

Asked by Serene of Sacramento, California

Expert answer

Hi Serene,

It sounds like you are in a frustrating situation. First of all, until you are taking the appropriate dose of thyroid medication and your TSH is in the normal range (I like to see it in the mid-normal range for my patients, around 2, for those that are struggling with their weight), it will probably be very difficult for you to lose weight.

The thyroid gland plays an important role in metabolism, and if your thyroid hormone levels are low, as indicated by a high TSH (thyroid hormone normally suppresses TSH when present at normal levels), your metabolism will be low and you will not burn as many calories every day.

When your TSH gets into the normal range, however, don't expect the weight to just fall off without continued effort. I find that most of my patients have to continue working very hard to lose weight even when their TSH is in the normal range. Without knowing your age, height, weight (especially where you tend to carry your excess weight - in the hips and thighs or in the belly), it's hard to make specific recommendations.

I think trying a nutrient-dense 1,200-calorie diet with fewer starchy carbs like bread, crackers, pasta, rice, cereal and baked goods might be useful, especially if your waist is greater than 35 inches (40 inches for men). Try to eat lean protein with most meals and snacks as this can give you a slight metabolic boost and having a cup or two a day of green tea (decaf is OK if you can't tolerate caffeine) could give you a slight metabolic boost as well, especially before exercise (check with your cardiologist regarding the caffeine since I don't know the nature of your heart problem).

As far as exercise, 10,000 steps a day is terrific. If you have the time and energy to increase to 15,000 steps per day, that could help. The latest government guidelines suggest that some people may need 90 minutes per day of exercise to lose weight. If your cardiologist approves, you might consider adding in hills on a regular basis to work your muscles differently and burn more calories.

In addition, I would definitely add strength training at least twice a week to build calorie-burning muscle. If you begin a strength training program, the scale may not move right away, but it should in the long run and it will help you keep the weight off.

Finally, for optimal heart health, a low-fat diet is not the best approach. A better idea would be to follow a moderate fat diet (about 25-30%) and substitute healthy fats like nuts, seeds, avocado, fatty fish, olive oil and canola oil for saturated fat like butter, cheese, cream and sugary and refined carbohydrates (Choose whole grains, which are heart healthy.).