As evidenced by the clinical symptoms in hyper- or hypothyroidism, thyroid hormones have strong effects on cardiovascular and metabolic functions. While these actions had been initially attributed to direct molecular mechanisms in the respective peripheral tissues such as heart, muscle or adipose tissue, a recent paradigm shift has occurred with accumulating observations that demonstrated important indirect effects via the brain on these systems. However, the individual contributions of the peripheral versus central thyroid hormone actions for the well-known phenotypical symptoms are still not entirely understood. Similarly, the neuroanatomical substrates for these central actions have remained largely enigmatic, although many studies point to the hypothalamus as a major target of thyroid hormone action. This review critically discusses the role of the central actions of thyroid hormone for the regulation of heart rate, body temperature, energy expenditure and food intake, and integrates some novel findings to summarize the current state of the field.