Why does my face get fat when I have a thyroid condition?

If you have an autoimmune thyroid disorder such as Graves disease or Hashimoto’s, you may have noticed your face getting fatter or thinner without good reason.

When the active hormone (T3) is low, your body has a natural disposition to not only hold water facially but also deposit fat there.

Water retention can be rectified relatively quickly. If you don’t mind playing with your health, take 50mcg QD (roughly the same as day-long endogenous production) and each day your cheeks will be more sucked in and you’ll lose the double chin. You may also lose it from around your ankles too ("cankles").

But, the fat deposition is curious. The best solution I have found is to keep FT3 stable.

The times I have had a fat face, people have asked if I have a condition or am using corticosteroids. That is rather upsetting, and has made me dodge photos for years when I have a "fat face day".

What's worse: when you are training hard, be it cardio, strength training or endurance, my regular blood tests show the instability of FT4 and FT3 and require additional supplementation. Usually, this means +25mcg QD thyroxine and, if I am using T3, 25 - 50mcg QD.

In summary, I have ripped myself to 4% body fat for stage condition in a physique show and my face never gets the chiselled look like it would have before I had Graves and took RAI.

Note: Those with autoimmune thyroid conditions often claim to have issues with cortisol, e.g. hypocortisolism. This may also be a contributing factor, but is very hard to measure (saliva tests) and diagnose. I do not put much weight in this theory.