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Thyroid UK
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Hypothyroid and underweight?

Can this happen? Also with central hypothyroidism? Can you get hypothyroid face when underweight? My face continues to change and it's like I have myxedema :( I want to post my photos but am too ashamed. I will PM if anyone can help.

Thank you.

25 Replies


What is 'hypothyroid face'?

Some hypothyroid patients are underweight and have difficulty gaining and maintaining weight. I was advised to eat frequent small meals to help gain and maintain weight and I also found protein shakes in between meals to be helpful.


A Dr said it to me once (hypo face) puffy, swollen with thickened skin. What is your diet like? I react to everything and it's hard to gain weight because of it, plus my periods have stopped so have to eat a lot, yet everything I eat makes the hypothyroidism worse :( Can you let me know your daily diet please?



I don't eat much as I no longer have much appetite. I do drink a lot of milk. Nevertheless my diet wouldn't pass muster with any dietician and isn't something I recommend. Your diet won't be making your hypothyroidism worse. You need to eliminate foods which make you feel ill or cause an allergic reaction and eat plenty of the foods you tolerate.

Can you post your recent thyroid results and ranges so we can see whether you are optimally dosed?

Also post any results you have for ferritin, vitamin D, B12 and folate.


I have posted below. What you say an allergic reaction, what are your symptoms when you get one? I can't even drink bottled water unless it's has been boiled! Madness.



Why do you have to boil bottled water before drinking it? I don't know what your allergic or adverse reactions are. I'm not allergic to foods. I avoid some because they give me indigestion or heartburn or repeat on me, otherwise I eat what I like.

If you are not diagnosed and taking Levothyroxine your results are euthyroid (normal).

If you are prescribed Levothyroxine there is scope to increase your Levothyroxine dose to raise FT4 and FT3. The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.3 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email louise.roberts@thyroiduk.org if you would like a copy of the Pulse article to show your GP.

Thyroid antibodies are negative for autoimmune thyroiditis (Hashimoto's).

Active B12 is good.

Folate could be higher. Optimal is halfway through range. You can raise folate by supplementing folic acid or methylfolate for 3-4 months and eating more leafy green veg.

VitD 34.3 is insufficient. VitD is optimal around 100. I would supplement 10,000iu daily x 6 weeks, then reduce to 5,000iu x 2 months, and then reduce to 5,000iu alternate days and retest in April. Take vitD 4 hours away from Levothyroxine.

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Do you have the results of any blood tests to share because that would make it easier for people to comment on whether hypothyroidism seems like an appropriate diagnosis?

Typically, it's helpful if you have results and reference ranges for:

TSH, FT4, FT3, thyroid antibodies.

And a range of vitamins and minerals, including:

vitamin D

vitamin B12



and the usual iron levels, FBC (full blood count) etc.

As your periods have stopped, have you had any investigations for that?


I had bloods on NHS and bloods via Medichecks and both were different. Periods stopped due to low weight as reacted badly to everything I ate (still do) - am also nearly bald due to hair loss and I'm only 30. I will find my last lot of medicheck results but I lost my NHS ones and she wouldn't give me a very comprehensive list, only read out the ranges with no comparison and I wrote them on my phone.


Nhs test done 2 weeks before medicheck test: Results were: TSH 0.57

T4 10.4

Prolactin :105. Medichecks results -

Thyroid Function


FREE THYROXINE 15 pmol/L 12.00 - 22.00

TOTAL THYROXINE(T4) 76.0 nmol/L 59.00 - 154.00

FREE T3 3.47 pmol/L 3.10 - 6.80




ACTIVE B12 106.3 pmol/L 25.10 - 165.00

FOLATE (SERUM) 10.6 ug/L 2.91 - 50.00

25 OH VITAMIN D *34.3 nmol/L 50.00 - 200.00

Interpretation of results:

Deficient <25

Insufficient 25 - 49

Normal Range 50 - 200

Consider reducing dose >200


I think the use the same labs - Medichecks and NHS so how could TSH go from 0.57 to 0.939 in two weeks. Or is this normal?


That's quite a normal fluctuation in TSH as it varies throughout the day and depending on how recently you've eaten. This chart shows how it can vary: healthunlocked.com/thyroidu...

Were both of the blood tests as early in the morning as practical? Did you fast overnight (water allowed) This gives a good chance of catching the highest reading of TSH in your day which can be useful when assessing the TSH as part of a diagnosis.

You're negative for both types of thyroid antibodies, so there's no indication of Hashimoto's - tho' as antibodies fluctuate you might want to test this at a later date.

Are you supplementing for vitamin D as you're in the 'insufficient' category?

I know very little about active B12 but that looks like it's more than half-way through the reference range.

What has the GP said about the hair loss and the cessation of your periods?

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Thanks for this. Yet every Dr I have seen - dermatologists, Gap's tell me I look like I have hypothyroidism. It's bizarre!


To me your results scream Central Hypothyroid


How so? Please could you let me know as seeing endo next week.Thank you for this btw.


You have




All of which screams Central /secondary / pituarity or maybe Tertiary Hypothyroid

Its not your thyroid thats faulty its the pituarity or hypothalmus

Usually this is accompanied by

High cholesterol

Low ferritin

Low folate

Low vit b12

Low vit d3

Have you ever had massiveblood loss or sustained a head injury

Are others in your family Hypothyroid

If your physical appearance also screams hypothyroid can yo take photos of what your face was like before all this started

Take an assertive person who is able to read up and understand all the above then you should not be browbeaten


Another user has commented I definitely don't have central hypothyroidism by my bloods so am a little confused. Yes, low vit d3 and yes, two separate head injuries that put me in hospital. I have Asperger's so apologies if In coming across as annoying.


*if I'm coming


I have not seen a comment saying you ddfinitely dont have Central Hypothyroid

If you havd sustained 2 blows to the head and have a puffy face plus low vitamin levrls along with what are low TSH lowish T4 and low t3 i would still suspect Central or tertiary hypothyroid or an adrenal issue

Aspergers runs on thyroid families too

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healthunlocked.com/thyroidu... it may not be central hypothyroidism to some, but don't know enough about it which is why I'm so grateful for everyone's opinions here. X


Your prolactin is low, so that would suggest you don't have a prolactinoma, but head anjuries could cause damage to the other half of your pituitary or the stalk. Can you request an MRI scan? Have you been referred to a specialist due to hairloss or lack of periods? If the doctor's you've seen suggest you look hypothyroid, why have they not precribed levothyroxin?

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Hi just another thought, it is possible that you are not eating enough. Im trying to find a link I read recently but failing at the moment! It related to thyroid levels and calorie intake.

Basically it said that our bodies react to famine situations by suppressing thyroid hormone production in order to lower our metabolism and save energy until the famine passes. This would explain why your TSH is not raised despite low in range FT3 and barely mid range FT4. Do you measure calories? If not it may be worth doing for a while to see if this could be the issue. It could mimic central hypo as your pituitary would not be asking for more production, not because it is broken but as a survival safety mechanism.

I was low or deficient in all the essential nutrients and correcting them made a huge difference to brain fog, fatigue and various aches and pains that levo had not been able to correct. Although they are hypo symptoms, we have to be careful not to blame everything on it, that is why they are called non specific symptoms, they can also be caused by other things too.

Low thyroid hormone levels play havoc with our digestion, causing low stomach acid especially, which affects nutrient absorption. I had terrible reflux issues if I ate a carb heavy meal or a protein heavy meal. I did help this by taking a digestive enzymes capsule with meals until my levels improved. This suggests to me at least that the production of digestive enzymes may well be affected by low thyroid hormone too. For you I could see that becoming a vicious cycle causing you to have issues with more and more foods.

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Yes, I read an endocrinologist talking about people with low calorie/fasting diets and how they are more prone to hypo. Especially Celtic races apparently- Scottish, Welsh, Irish. How is your diet at the moment? X


Once I got my thyroid levels to a good place my digestion improved a lot, especially protein (no longer feel like Ive eaten a brick after a good steak). Carbs are still a bit iffy and a carb heavy meal can cause a return of the reflux, only one that doesnt do this is brown rice so tend to have rice bolognaise etc instead of pasta.

I had been high protein low carb for a long time due to weight issues and it took me a while to readjust to a more balanced diet (caused all sorts of problems at first so had to take it slow).

GreyGoose had advised that too low carb was counterproductive for hypo and that we need minimum nutrient levels and a balanced diet to produce and convert thyroid hormone effectively whether synthetic or our own. I was already addressing nutrient levels and starting to feel better so I bit the bullet and persevered with adding back in some more carbs. My weight stabilised and thyroid levels balanced with each other better so I am now careful to avoid low carb. Before I was gaining if I ate more than 1200 a day now I can have 1600 and maintain which is a big improvement so just have to work out a safe number to start losing without triggering famine again.

Some drs think that if you are struggling to gain weight you cant have under active thyroid issues. Although weight gain is a classic side effect of low thyroid levels, weight loss can be too. Many symptoms can be a feature of both over or under-active thyroid or weight may not be affected at all.

I still have a supply if my enzyme capsules and pop one if I am going to have an unusually heavy meal. Its also handy that if I start having issues its not too late to have one when I get home so can get an accurate feel for when I actually need the extra support or what sets me off rather than have to rely on them fir every meal. They are just a basic dietary enzyme off amazon, my friend is very dairy intolerant but pinches a couple so she can steal my icecream when she comes round!

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Also thank you for your well informed reply.


I also take Jarrow Enzyme Plus and have been for 8 weeks.


I was told by a dermatologist who noticed my orange skin and puffy face when I saw him about a mole on my leg. My NHS endocrinologist is a rude, recently graduated type with no time for anything off the books or on a computer screen (the bloods). Did many give up on being diagnosed by NHS? I am seeing a private endo at the London endocrinology centre, sadly it's not the main man there as he's booked up until Christmas. I have heard of one outside the NHS - Dr P(Ive stupidly forgotten his full name!) but he's apparently a lot like the late Dr Skinner. My current NHS endo says periods stopped because of low weight and hairloss, it's easy for them that way see, but my weight went down becsuse I was in pain when I ate (stomach) and my vision would go funny too and I'd get (and still do) a tightening and swelling around the eyes after I ate. Its beyond at the moment. Cognitive wise, I can't think straight, so I therefore apologise for my messages. I type on my phone as I can't even manage a laptop as it's so overwhelming and my brain fog has got to the stage where I can barley function anymore. I have quit work and am now housebound. 30 years old, nearly no hair left, eyebrows and lashes falling out, aching limbs, feeling immensely tired but plagued with anxiety ridden insomnia, unable to digest foods, reacting to the slightest things around me and yet Dr blames it all on low weight when there's much more to it than that. It's a horrible circular thing I can't get a grasp on which is why I'm desperate for a decent Endos. I've put on a stone and half in 4 months yet the symptoms keep getting worse and worse. I don't know if what I'm eating could be making any condition worsen. I'm gluten free and have tried eliminating other foods but nothing makes a difference


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