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Friday January 11th 2019


Imma Be Queen of Leptin: How It Rocks Your Thyroid

Post Published: 01 July 2010
Category: Guest Bloggers, Leptin Hypothyroid and Normal TSH Levels
This post currently has 21 responses. Leave a comment

(Written by, Dr. Sara Gottfried)

Ever wonder why you still feel hypothyroid yet your TSH is normal? Or why the weight you gained while hypothyroid hasn’t fallen away? A key intermediary hormone that many of us are unacquainted with is leptin, a regulator of both body weight and your thyroid control. Let leptin become your new BFF by getting to know her intimately and learning how she rocks your thyroid and weight.

If you haven’t heard of leptin, that’s because it was discovered relatively recently in 1994. It’s similar to insulin in its job description. Leptin acts as an important control system that makes telephone calls to other organs about the state of your fat balance and whether to go or stay in low-metabolism survival mode. It’s made in your fat cells, and more fat cells = higher leptin levels. The high leptin normally tells your hypothalamus that you don’t need to eat as much, so metabolism slows (you make more TRH, and this raises TSH) and the TSH tells your thyroid to crank out more thyroid hormone. This is when your leptin is communicating clearly and functionally, and your hypothalamus is responding appropriately.

Optimal Leptin

Ideally, leptin should be between 4-6. If your leptin is 4-6, your hypothalamus is getting the correct phone calls from leptin. If your level is above 10, your leptin receptors are fatigued, and the phone calls are no longer getting to or from the hypothalamus. Result? Metabolism slows inappropriately because the hypothalamus is interpreting the messages inappropriately.

Problem with Chronic Dieting

Chronic dieting and/or major stress are a common cause leptin resistance. As a result, leptin no longer has a clear line of communication with your hypothalamus and thereby your metabolism. Leptin resistance makes the hypothalamus believe that you are in starvation mode, and you make more fat, and slow down thyroid hormone production. TSH goes down, you don’t convert as much T3 (active thyroid hormone) from T4 (inactive), reverse T3 goes up, appetite increases (crazy unfair, sorry about that), and often you become insulin resistant, and slow down lipolysis (fat breakdown). More fat accumulates, you’re hungrier and you age prematurely. Not good!

Over time, you get fatter, especially at the mid-section, and it becomes increasingly difficult to lose the weight and fat. In fact, it takes herculean efforts.

High Leptin Renders TSH Unreliable

As if herculean efforts weren’t enough, If your leptin is high, TSH less reliably reflects your tissue level of thyroid hormones. For example, in diabetics who are almost universally leptin-resistant, T4-to-T3 conversion is cut in half without a change in TSH. While you may not be diabetic, you may still experience a significant reduction in your conversion before your TSH picks it up. This is where, yet again, measuring your free T3 (fT3) and reverse T3 (rT3) can help elucidate the issues.

More Bad News: Leptin & Thyroid Cancer

When your leptin rises in the blood, it increases (upregulates) leptin receptors on thyroid cancer cells causing them to become more aggressive. Does it help transform normal thyroid cells into malignant cells? We don’t know. But we do know that overzealous leptin receptors were found in 80% of thyroid cancers in one series published in 2009. Leptin has been shown to stimulate growth of thyroid cancers and reduce cell death.

How About PCOS?

Short version: leptin problems cause PCOS, both in lean and obese women. The science is quite complex, and involves loss of the timing of certain hormonal rhythms of both growth hormone and luteinizing hormone. From your comments to the last post, I’d like to offer a future blog post on all things PCOS, so please comment your questions and concerns.

OK, OK… Tell Me What to Do

Measure your leptin level. If it’s above 10, use nutrition as a first strategy to reset your level. I find that 70-80% of my patients are successful just by making the nutritonal changes that are recommended for reversing leptin resistance, such as Dr. Ron Rosedale’s program (http://www.drrosedale.com) or Byron Richards 5-step plan. Dr. Rosedale presents a food program in his book that includes elimination of fruit except avocadoes and olives for three weeks and limited starchy foods. There is far more detail in his book. I find the food changes are the primary way to lower leptin; nutraceutical supplements are another approach that may augment your success with leptin-sensitizing foods.

Here again (similar to what we reviewed in my blog post last week), we want to normalize both the thyroid and the leptin levels simultaneously for the best results. What works in those who are not successful with the nutritional program to lower leptin is to add prescription therapies. I don’t like the prescription approach – I favor using natural therapies but they require deep commitment to change old eating patterns. HCG treatment has also been successful, but that’s a hugely controversial approach that merits it’s own blog post!

While leptin resistant, make sure your free T3 and reverse T3 are being managed properly. I like to see the free T3 mid-range for your lab, and the fT3/rT3 >1.8 (when fT3 is in units of ng/dl).

As leptin lowers, your TSH will more accurately reflect your tissue levels, assuming you are also limiting stress and exposure to endocrine disruptors such as bis-phenol A (BPA) and other lovelies that mess with your thyroid receptors. One side note: probiotics have been shown to reduce BPA absorption, but that’s a big topic for another post too!

If I’m making this sound as if we have the whole leptin scene figured out, let me also mention that there’s a lot we don’t know. How insulin resistance interacts with, or causes leptin resistance, for instance, is still not completely clear.

Personally, I’ve found that optimizing leptin makes my thyroid care and weight management much more successful. I’ve reversed my leptin from 11 to 4 in 6 months. As the Black Eyed Peas might put it: “Imma be Queen of my leptin, getting it down lower than 6, Imma be the flyest chick….”

For more info, visit my website, blog and Facebook page, all available at Gottfried Center

Dr. Gottfried’s previous posts on Dear Thyroid: Crazy Happy Thyroid Dance.

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21 Responses to “Imma Be Queen of Leptin: How It Rocks Your Thyroid

  1. Dr. G, thank you SO much for writing this article!! I had absolutely no idea that leptin plays such an important role in our bodies. As a thyroid cancer patient, I’ll be paying close attention to my leptin levels from now on, guaranteed!

  2. Utterly fascintaing, thank you x

    I’m off to get acquainted with my leptin!

  3. faith72 says:

    Thank you,I’ll watch what I do from now. Now that I know leptin is what I got to watch on my levels…along with my TSH levels..

  4. DrGottfried says:

    glad you likey – it’s the missing piece for a lot of us! especially the chronic dieters, myself included!

  5. Linda says:

    WOW! Thank you so much! Every new finding and bit of new information that I get makes me feel so optimistic that someday I will be “normal” again. My friends and family say I was never “normal”, but all of you understand. Now it is time to call the Endo. and request a leptin test be added to my next work up. Thanks again!

  6. Dear Thyroid says:

    Dr G. You are the best, the very, very, best. I love your approach to medicine and this article was so fantastic.

    I don’t know if I’m insulin resistant. I know that I haven’t had my reverse T3 tested. I also know that I’m an absolute sundial. I am definitely hocking shmendo boy now.

    I wanna be queen a’ my leptin.

    Thank you for another magnificent installation.


  7. Lori says:

    Thank you, Dr. Gottfried.

    I have Hashimoto’s. My FT3 is still in the lower half of normal. I’m due to check that again in about 4 weeks on my increased dose of NDT. My RT3 was checked when I started with this doctor but only because I asked for it it to be checked, and it was “normal” but if I am correct in understanding you, it’s the ratio is what we need to look at, not the two of them individually? If this is correct, could you explain how we get the ratio from those two results. I am not understanding this part of it.

    I will definitely be asking to check my leptin when I f/u, as I am really struggling to lose the weight I put on. I thought it was because my FT3/4 are not optimal yet. Besides the nutritional component, what nutraceutical supplements would be used for this purpose?

    Thanks again for another awesome post:)

  8. sandy says:

    hoo boy,

    fluoride, soy, caffeine, gluten and now leptin. What is left to eat and drink?

  9. DAT says:

    Thank you Dr. G, more food for thought. You are simply marvelous 🙂

  10. DrGottfried says:

    thanks for your loving comments – i appreciate them very much. you guys are just great and getting better thyroidly all the time!

    on the fT3/rT3 ratio – thyroid math makes all of us a little skittish.

    usually free T3 is given either in ng/dL (ideal > 1.8) or pg/mL (ideal > 0.018). if your free T3 = 2.4 pg/mL and your reverse T3 is 300 pg/mL, then the ratio is fT3/rT3 = 2.4/300 = 0.008, which is low.

    healthy reverse T3 is < 250 pg/mL, but we're all along a continuum.

    hope that helps!

  11. Dr. G. Great article! I know you’re a regular contributor here, so I’ve been meaning to check out your work. This sounds like groundbreaking news for thyroid patients!

  12. Lori says:

    Now I get it, divide the ft3/rt3.

    Thx Very Much, Dr.G♥

  13. Joanna H. says:

    Wow! Thanks for this article. I have not been on DT for a while to read many postings as I have been constantly sick. (My Dr. thinks it’s my anxiety/PTSD. I wonder if it may be medication related.) Anyhow, I enjoyed reading your article as I am always looking for new info and still lacking in solid diagnosis, though in 2000 I was diagnosed as Hypothyroid and put on Synthroid. Since leaving that doctor to move to a new area though, the new doctor didn’t see any need for me to be on it any more and I have been fighting with weight, symptoms and doctors since. Thanks for this info! I wonder if doctors are on board about this one?

    ~Joanna H.

  14. Lolly says:


    Great explaination of Leptin and how it works. something maybe i need to look into TY for your Article it’s an eye opener and makes so much sense.


  15. Faren says:

    On my last test my FT3 was 2.95 pg/mL (1.80-4.20 range)
    and my RT3 was 31.4 mg/dL (9.0-35.0 range). If I’m converting the units correctly my ratio would be 2.95/314 = .0094. Is that correct? And we should be aiming for a ratio of .018 or greater?
    Thanks for another great article.

  16. DrGottfried says:

    That’s correct, Faren. I can’t give medical advice in this forum (I do that in my health coaching only), but more T3 would be a consideration or better conversion. Get your leptin checked.

    On the nutraceutical question – there are many. Ron Rosedale does a great job reviewing this in his book. Some of my favorites: N-acetyl cysteine, fish oil, gymnema, glutamine, pregnenolone.

  17. Bee says:

    Dr. G—I feel like saying “Oh, O-B-Whan (sp?),you’re my only hope”. FOR YEARS I’ve had this niggling feeling that the medical community in my inner circle has been missing something. You appear to possibly be providing me with the missing link. I will def print out this article for my next doc visit and have a sit-down and discussion session. It brings a ray of hope to my big fat ass and linebacker shoulders

  18. Sarah Downing says:

    Hi Sara, thanks again for a wonderfully informative post. I like the way your posts address some topics that are more complex and less talked about. Sometimes it is these topics that are parts of our puzzle to getting well. Looking forward to your next post!

  19. Michelle says:

    A month ago I made a life change and did a Leptin resistance diet. 2 weeks of strict meal plans and then modifying it to suit my lifestyle in the coming weeks and I am a new person. I have energy and have lost 11lbs…I have my life back. Only 8lbs more and I am back to pre-hypothyuroid ME!

  20. Maya says:

    Thank you Dr.G for this article, I asked my primary phys. to order some tests , but it seems no one knows what to do with results. I have Hashimoto and my Leptin is 15.9 ng/ml. FT3 4.6 pg/ml, and RT3 28 ng/ml. And what is that means I have no idea, I took the results to my endo but he ignored it. Should I be worried or the ratio and Leptih is OK. I would really appreciate your respond.

  21. Judy says:

    Just got test result mine 38.5! Yikes.

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