Your concern about underlying hormonal factors is very valid. Hypothyroidism, even when being treated, is a significant barrier to weight loss if the
TSH is not optimally controlled (target TSH for weight management is ideally 1â2 mIU/L, not just 'within normal range'). Additionally, PCOS and insulin resistance are extremely common in young women with hypothyroidism and together create a perfect storm for stubborn weight gain despite calorie restriction. Regarding GLP-1 medications like semaglutide (Wegovy) or tirzepatide (Mounjaro): at a BMI of 28.2 with hypothyroidism as a comorbidity, you do meet the threshold criteria for these medications, and they can be effective. However, they work significantly better when
thyroid function is first optimised, and they do have side effects (nausea, GI symptoms) that need monitoring. They should be started only after a thorough hormonal evaluation.
Next Steps
Get these tests first:
TSH + Free T4 (to assess
thyroid control), fasting insulin + HOMA-IR (for insulin resistance),
HbA1c,
LH:
FSH ratio,
testosterone, DHEA-S,
prolactin,
Vitamin D, and a pelvic ultrasound (to rule out PCOS). Based on the results, a doctor can determine whether dose adjustment of thyroid medication is needed and whether GLP-1 medication, metformin, or other treatment is appropriate. Focus on strength training rather than cardio for best results with hypothyroid weight gain. Please consult me directly on Practo for a detailed evaluation.