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Medical Barriers: Endocrine Disorders II

Today’s post is another excerpt from “Best Weight: A Practical Guide to Office-Based Weight Management“, recently published by the Canadian Obesity Network.

This guide is meant for health professionals dealing with obese clients and is NOT a self-management tool or weight-loss program. However, I assume that even general readers may find some of this material of interest.


Although hypothyroidism is associated with some weight gain, in most obese patients, thyroid hormones are within normal levels. Hypothyroidism is associated with fluid retention and decreased resting energy expenditure, which may also contribute to weight gain. A patient with hypothyroidism that is severe enough to cause weight gain will, in virtually all cases, also display the other symptoms of hypothyroidism.

Routine testing of thyroid hormones should be discouraged. Only patients with symptoms suggesting hypothyroidism (such as dry hair and skin, cold intolerance, hair loss, difficulty concentrating, poor memory, constipation, muscle cramping, menorrhagia and/or goitre) should be investigated.

Cushing’s Syndrome

Ruling out Cushing’s syndrome in patients with obesity is a clinical challenge, as obesity is one of the hallmark features of the disorder. The classic fat distribution of Cushing’s syndrome is central, without affecting the extremities. Many metabolic abnormalities (hypertension, diabetes, hirsutism, menstrual irregularities) are found in both obesity and Cushing’s syndrome. Certain features characteristic of Cushing’s syndrome (easy bruising, purple striae, skin atrophy, proximal myopathy, hypokalemia, etc.) should prompt further investigation. The differential diagnosis of obesity from Cushing’s syndrome and pseudo-Cushing’s syndrome is clinically important for clinical decisions.

Cortisol levels are used to diagnose Cushing’s, but obesity alone often causes elevated morning cortisol levels. If Cushing’s is suspected, 24-hour urinary cortisol is a more sensitive test.

© Copyright 2010 by Dr. Arya M. Sharma and Dr. Yoni Freedhoff. All rights reserved.

The opinions in this book are those of the authors and do not represent those of the Canadian Obesity Network.

Members of the Canadian Obesity Network can download Best Weight for free.

Best Weight is also available at Amazon and Barnes & Nobles (part of the proceeds from all sales go to support the Canadian Obesity Network)

If you have already read Best Weight, please take a few minutes to leave a review on the Amazon or Barnes & Nobles website.


  1. I am wondering whether you could address appropriate TSH levels in hypothyroidism. I’ve seen disagreement with some saying normal is .3 – 3.0 and others going .5 – 4.5 or 5.0 so.

    I ask because a few years ago I showed many symptoms of hypothyroidism — sluggish, fatigued, depressed, gaining weight, going through gallons of moisturizer and hair conditioner, but I kept testing high normal (using the higher range), so doctors kept telling me there was nothing wrong with me and I just needed exercise and antidepressants. I’m being treated more appropriately now, but I’m wondering how many people out there are hypothyroid high-normal and being told that’s not the issue.

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