Methimazole, known also as Tapazole, is a medication prescribed to manage hyperthyroidism. Hyperthyroidism is a condition where the thyroid gland produces excessive thyroid hormone. This article explores the potential for weight gain following methimazole treatment, delving into the underlying mechanisms and offering strategies for managing weight.
The Interplay Between Thyroid Hormones and Weight
The thyroid gland plays a pivotal role in regulating the body's metabolism through the secretion of hormones. Metabolism encompasses the chemical processes that convert food and drinks into energy. When the thyroid gland is overactive (hyperthyroidism), it secretes more hormones than the body needs, increasing metabolism and often leading to weight loss despite an increased appetite. Conversely, an underactive thyroid gland (hypothyroidism) results in decreased thyroid hormone production, slowing down metabolism and potentially causing weight gain.
Symptoms of hyperthyroidism include:
- Weight loss with increased appetite
- Rapid or irregular heartbeat
- Nervousness
- Irritability
- Shakiness
- Muscle weakness
- Sweating
- Heat intolerance
- Frequent bowel movements
- An enlarged thyroid gland (goiter)
Methimazole's Role in Hyperthyroidism Treatment and Potential Weight Gain
Methimazole functions by blocking thyroid hormone activity, thereby reducing metabolism. While this action effectively addresses hyperthyroidism, it can also contribute to weight gain.
Untreated hyperthyroidism can lead to serious complications, particularly heart problems. Treating hyperthyroidism often leads to weight gain. The American Thyroid Association notes that people often regain any weight they lost once treatment begins. Additional weight gain may result from habitual overeating during the hyperthyroid period, even after metabolism stabilizes. It can also indicate a new hypothyroid state, especially if the thyroid gland has been eliminated or removed.
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A 2018 study observed weight gain in six participants treated for hyperthyroidism with methimazole during the first two months of treatment, followed by a plateau until the sixth month. Research indicates that after starting methimazole, typical weight gain was about 12 pounds in 42 people with Graves’ disease.
A study aimed to determine whether treatment of hyperthyroidism is associated with increased risk of developing obesity. The study found that after treatment men were 1.7 times and women were 1.3 times more likely to develop obesity. Weight gain occurred mostly in the first 6 months of treatment but continued until 24 months. A total of 65% of patients gained 5% of their weight and 38% gained 10% or more. Men gained on average 17.6 lbs and women gained about 12.1 lbs. Average weight gain was about 11.8 lbs for patients who were treated with medication, 12.3 lbs for those who had RAI treatment without developing hypothyroidism, and 15.6 lbs for those who had RAI treatment and developed hypothyroidism.
Understanding the Metabolic Changes
Research has explored the changes in basal metabolic rate and body composition following treatment for Graves' disease. A study involving six women newly diagnosed with Graves' disease monitored body composition, resting respiratory expenditure (REE), and handgrip strength during a 52-week methimazole treatment.
The study revealed that after methimazole treatment, body weight initially increased (0-8 weeks), plateaued (8-24 weeks), and gradually decreased later (24-52 weeks), despite decreased food intake. The measured REE was 40% higher than the predicted REE at baseline and gradually decreased after treatment. REE positively correlated with thyroid hormone levels, peripheral deiodinase activity, and thyroid's secretory capacity. Body composition analyses showed that fat mass increased during an earlier period (4-12 weeks), while lean mass increased significantly later (26-52 weeks). Consistent with the lean mass changes, muscle strength also significantly increased during the later period.
Key Findings on Methimazole Treatment and Body Composition
The study highlighted several key findings:
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- Treatment-related acute weight gain during the initial 6-month treatment of hyperthyroidism is reversed during the next 6 months with the recovery of normal thyroid function.
- Antithyroid treatment results in increased body weight along with decreased REE despite decreased food intake.
- Compositional analyses showed that fat mass increased during the initial 3 months and then reversed itself, while lean mass and muscle strength increased in the later 6 months, suggesting body composition changes in a better direction.
Managing Weight Gain After Methimazole Treatment
Several strategies can help manage weight gain following methimazole treatment:
Lifestyle Adjustments:
- Balanced Diet: Emphasize a well-balanced diet to support a moderate weight, regardless of thyroid function. Nutrients that may help support your health with an overactive thyroid include calcium, vitamin D, zinc, iron, and selenium. Incorporate plenty of fresh fruits and vegetables, whole grains, and lean fats.
- Regular Exercise: Regular exercise is an important part of wellness regardless of the state of your thyroid gland. The effects of exercise on cardiovascular health, muscle development, and weight management are well known. Research shows that physical activity can also help ease inflammation in the body. The anti-inflammatory effect of exercise is particularly useful in thyroid disease since both hyperthyroid and hypothyroid conditions are often linked to autoimmune disease.
Medical Management:
- Monitor Thyroid Function: Regular monitoring of thyroid hormone levels is crucial to ensure proper medication dosage and prevent hypothyroidism.
- Medication Adjustment: If hypothyroidism develops, thyroid hormone replacement therapy with levothyroxine may be necessary to restore normal thyroid hormone levels.
- Consult Healthcare Provider: Discuss any concerns about weight gain or other side effects with your healthcare provider. They can provide personalized advice and adjust your treatment plan as needed.
The Importance of Awareness and Comprehensive Treatment
The risk of weight gain can be very scary, however, hyperthyroidism needs to be treated otherwise it can become very severe and even lead to deadly complications. The most important step to control weight gain from any cause is to increase the awareness of providers and the patients.
Usual treatments for hyperthyroidism include:
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- Beta-blockers to lower hyperthyroid symptoms
- Antithyroid medications like methimazole to reduce thyroid hormone production
- Radioiodine therapies that destroy thyroid cells
- Surgery to remove your thyroid gland
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