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When thyroid hormone levels are low, metabolism slows, leading to: Reduced resting energy expenditure: The body burns fewer calories even during basic functions Fluid retention: Hypothyroidism causes mucopolysaccharide accumulation in tissues, leading to a specific type of swelling called myxedema Fatigue and reduced activity: Low energy levels make consistent exercise challenging Altered appetite signaling: Thyroid hormones influence leptin sensitivity and appetite regulation Insulin resistance: Hypothyroidism is associated with impaired glucose metabolism, making fat storage more likely (Duntas & Brenta, 2018, Thyroid ) Even with adequate levothyroxine replacement, many hypothyroid patients report difficulty losing weight