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10 Things to Know About Thyroid Disease and Fatigue

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Updated August 18, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

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However you describe it -- exhaustion, weakness, lethargy, or feeling run down, sluggish, overtired, or just plain pooped out -- fatigue is a common symptoms of a thyroid problem. You may find yourself needing a nap in the afternoon just to make it to dinnertime. You may sleep ten or twelve hours a night and still wake up exhausted. You may find yourself less able to exercise, and your endurance drops because of weakness or lethargy. Or you just walk around spaced out on the same amount of sleep that used to leave you feeling refreshed.

There are a number of important things to know about the key connection between fatigue and thyroid conditions, and ten of the most important ones are outlined here. Thyroid patients have shared some of their fatigue-fighting secrets, but here are some of the key things you can do to improve energy and fight fatigue.

1. Fatigue and Hypothyroidism

Fatigue is a very common symptom of hypothyroidism - an underactive or low thyroid -- in many patients. When the treatment for hypothyroidism is optimized, many patients report that their fatigue is lessened or even fully resolved.

2. Fatigue and Hyperthyroidism

Fatigue is a symptom of hyperthyroidism -- an overactive or high thyroid -- in some patients. In some cases, fatigue is present even after you've gotten a sufficient amount of sleep. In other cases, fatigue in hyperthyroidism may result from insomnia, anxiety, or disrupted sleep patterns. Typically, appropriate treatment for Graves' disease and hyperthyroidism will help resolve fatigue associated with an overactive thyroid.

3. Fatigue and Autoimmune Thyroid Disease

Even when thyroid function tests show that the thyroid is "normal" and hormone levels fall within the reference range, the presence of elevated thyroid antibodies indicative of autoimmune Hashimoto's disease or Graves' disease can cause fatigue as a symptom in some patients.

4. Dietary Changes

Some thyroid patients -- including those who do not have celiac disease or gluten intolerance -- have reported a reduction in fatigue when they switch to a gluten-free diet, free of wheat and gluten products. Others have reported similar effects by eliminating sugar, or other inflammatory foods from the diet.

5. Unrefreshing Sleep

Some people experience fatigue due to what's known as unrefreshing sleep. This means you've had enough sleep -- usually seven or more hours -- but you wake up and still feel tired, because the sleep was of poor quality, interrupted, or did not reach restorative levels. Unrefreshing sleep may be associated with adrenal dysfunction, as well as chronic fatigue syndrome and fibromyalgia.

6. Iron

Some thyroid patients experiencing fatigue may be low in iron, in particular, the stored form of iron known as ferritin. It's worth having ferritin levels checked by your physician, and if they are not optimal, talk to your doctor about supplementing with iron, or adding more iron to your diet through foods.

An excess of iron, in particular a hereditary condition known as hemachromatosis, can also be associated with fatigue.

7. Chronic Fatigue Syndrome and Fibromyalgia

If you have long-term, debilitating fatigue, and the fatigue is accompanied by other symptoms such as enlarged lymph nodes, a chronic sore throat, and/or body/muscle aches pains, you may have other conditions, known as Chronic Fatigue Syndrome and/or fibromyalgia. these conditions are more common in thyroid patients than in the general population.

8. T3 and Natural Thyroid

Some thyroid patients on thyroid hormone replacement have reported an improvement in their fatigue levels when switching from a T4 only treatment (i.e., levothyroxine), to a T4/T3 treatment--for example, the addition of synthetic T3--or use of a natural desiccated thyroid drug.

9. Sleep Apnea

Thyroid patients are at greater risk of sleep apnea, where breathing stops for short periods during sleep. Sleep apnea can contribute greatly to fatigue. Thyroid patients experiencing fatigue should talk to a physician about having a sleep study or evaluation done to determine if sleep abnormalities -- including apnea -- may be contributing to the fatigue.

10. You Can Get Better Sleep

In addition to making sure you get optimal thyroid treatment for your condition, and address any sleep disorders, food sensitivities, and imbalances in iron levels, there are many other ways to ensure that you get sufficient sleep.

But first, how much sleep do you need? According to the National Sleep Foundation most adults need a minimum of seven to eight hours per night, and a substantial percentage of us are not getting this amount of sleep on a regular basis.

Here are some tips to get to sleep, and get better sleep:

  • Try to keep the same sleep schedule weekdays and weekends
  • Keep your bedroom cool
  • Don't watch television or work in your bedroom
  • Avoid caffeine and alcohol in the afternoon, and before bedtime
  • Don't take naps.
  • Don't exercise after dinner time
  • Take a hot shower or bath before bedtime
  • Use a sound conditioner or earplugs to block noise
  • Avoid large meals before bedtime
  • Increase light exposure during the day
  • Minimize light in your bedroom -- Use blinds or blackout curtains, turn off television and computer at night, avoid illuminated clocks, and don't read from backlit devices at night
  • Listen to relaxation or guided imagery tapes to help fall asleep
  • Don't drink too much liquid in the evening
  • Limit changes in your work shifts
  • Drink an herbal or relaxation tea at bedtime
  • Have a bedtime snack with protein

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