While obesity has been historically considered a criteria to establish the diagnosis of hypothyroidism, the association between them is seldom encountered in patients. Nowadays the main metabolic criteria is the gain of weight in the presence of other symptoms of hypothyroidism. The large differences between the thermogenesis of hypothyroid and hyperthyroid patients underline the complex relationship of thyroid hormones and metabolic pathways. The treatment of a subclinical hypothyroidism has almost no influence on the body weight, whereas in more severe dysfunctions a weight loss is expected, usually less than 10% of body weight. Thereafter severe obesity may not be secondary to a thyroid failure.