Q. I'm told I have a thyroid issue, but why am I actually gaining weight?

Physiologically, excess thyroid hormone accelerates metabolism, which should result in weight loss. However, in clinical practice, we frequently encounter patients who experience profound lethargy and dizziness alongside weight gain. This is essentially a problem of 'energy efficiency.' From the perspective of Traditional Korean Medicine (TKM), this is viewed as a state of Spleen Deficiency (脾虛). While the 'engine' (thyroid) continues to run at high speed, the 'fuel supply' (digestive absorption) is impaired. The body perceives this as an emergency and attempts to store all available nutrients. When these nutrients are not properly metabolized, they transform into Phlegm-Fluid (痰飮). Combined with Blood Stasis (瘀血) caused by stagnant circulation, this leads to edema and a feeling of heaviness in the body. The process typically progresses as follows: 1. Initial Stage: Metabolism overheats, causing temporary weight fluctuations and extreme fatigue. 2. Intermediate Stage: Body fluids are depleted and vital energy drops, leading to a sharp decline in metabolic efficiency. 3. Advanced Stage: Accumulated waste (Phlegm-Fluid) builds up, resulting in weight gain and bloating even with low caloric intake. Rather than a simple calorie-restricting diet, the priority should be to soothe the 'overheated engine' and restore the Spleen's function of Transformation and Transportation (運化)—the ability to process and distribute nutrients. It is crucial to accurately diagnose where your current metabolic rhythm stands.