In women, for example, the polycystic ovary is mostly responsible. However, it is still important to undergo regular thyroid assessment, especially at an older age, as well as a close and comprehensive follow-up, together with an adequate diet and physical exercise plan.

People usually associate obesity with hypothyroidism, however this association may not exist, nevertheless it is important to carry out hormonal analyses to measure thyroid functioning (TSH and free T4), even though non-specific signs and symptoms of hypothyroidism may not exist, leading to it being underdiagnosed.

However, there may be an indirect association between both conditions. A person who suffers from hypothyroidism, feels tired, and a tired person, moves less and does less exercise, or none at all. In this way, hypothyroidism is an indirect factor in weight gain because, less exercise, burns up less calories. In addition, hypothyroidism causes a decrease in metabolism and therefor the body uses less energy. In addition, hypothyroidism can cause depression and this also contributes to obesity. A person who is depressed moves less, is less active and sometimes, especially if the person is overweight, has more appetite.

In this way, physical exercise is currently considered the therapeutic weapon for the patient with the these two already established diseases, since physical exercise is more relevant in the control of obesity, and drug therapy is the great ally of hypothyroidism. However, physical exercise continues to be a therapeutic measure which is not prescribed by doctors. This is mainly due to the lack of knowledge of its importance in general health as well as in certain specific pathological conditions, but above all due to lack of knowledge of its parameters, such as type of exercises, intensity/load, repetitions, number of sessions, etc.

On the other hand, it is important for doctors to be on the lookout for muscular pain and arthralgia, frequent symptoms of hypothyroidism and which can affect the patient’s reluctance for any type of physical activity. Doctors should break the cycle; pain-inactivity - deconditioning-pain.

The conclusion which is reached is that in the face of obesity, regardless of its origin or causes, nutrition and exercise must always intervene, even if the exercise is mild. As far as diet is concerned, regardless of the diet chosen (and there are always many available) reducing calories is fundamental.

Obese patients that have lost weight and also suffer from hypothyroidism, follow-up is necessary. It must be remembered that exercise and reducing calories must be maintained so that the patient does not gain weight once again (about 80% of patients who interrupt nutritional monitoring, return to their previous weight within one year). There is also the need to monitor thyroid function and to measure values that might need to be adjusted as the thyroid is a very sensitive organ. It is in fact the “dictator” of our metabolism.

Finally, it must be remembered that a person that is obese is always a complex patient with multiple comorbidities such as diabetes, hypertension, dyslipidaemia, gastroesophageal reflux, osteoarticular problems, increased risk of multiple cancers and multiple cardiovascular complications, which is why follow-up must also be structured in a systematic way by a multidisciplinary team.

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